LIBRARY OF CONGRESS. 

(Bfmti Gcpjjrigfrt fir 



UNITED STATES OF AMERICA. 



DIPHTHERIA: 



— ITS- 



CAUSES, PREVENTION 



AND 






PEOPEE TBEATMENT. 



J. H. KELLOGG. M. D., 

MEMBER OF THE AMERICAN PUBLIC HEALTH ASSOCIATION, 
THE AMERICAN SOCIETY OF MICROSCOPY, THE MICHI- 
GAN STATE MEDICAL ASSOCIATION, AUTHOR OF 
NUMEROUS WORKS ON HEALTH, ETC., ETC. 




PUBLISHED BY THE 

GOOD HEALTH PUBLISHING CO. 

BATTLE CREEK. MICH. 













Entered according to Act of Congress, in the rear 1879. 

By J. H. KELLOGG. M. D.. 
In the Office of the Librarian of Congress, at Washington. 



PREFACE. 



The great prevalence and fearful fatality of diphtheria 
during the last few y ears has created a popular demand for 
information regarding it. In answer to this desire for knowl- 
edge, numerous fragmentary articles have appeared in the 
newspapers on the subject, some of which have been of a 
useful character, while the majority, have been more sensa- 
tional than practical. The object of this work— whether at- 
tained or not the reader must judge — has been to supply this 
demand more fully than it has been met heretofore. 

The more intelligent and observing members of the medi- 
cal profession everywhere, now generally recognize the fact 
that the greatest need of the times is popular medical litera- 
ture. The common people need to be taught how to take 
care of themselves when sick as well as when in health. Pre- 
ventive medicine is of much greater importance than curative 
medicine, since it directly concerns a much larger number of 
individuals, and if applied successfully, obviates, in large 
measure, the necessity for medical treatment. In order 
to make measures preventive of disease of really practical 
value, the people must be educated on the subject of disease, 
its nature and causes, and must become acquainted with the 
rationale of curative measures, which should in all cases be 
based, primarily, on the removal of causes. 

This monograph is not intended to supersede the necessity 
for a physician in the treatment of the disease considered, 
but rather to render those who may peruse its pages so in- 
telligent on the subject that they may be able to so efficient- 

(iii) 



iv PRE FA* '?:. 



ly second the efforts of a wise physician as to greatly increase 
the chances of a favorable issue. 

It is desired that parents and all who have the care of 
children, who are especially subject to this disease, should 
become sufficiently acquainted with its nature, causes, and 
most prominent phenomena, to be able to discover the dis- 
ease at its first appearance ; to appreciate the importance of 
employing energetic measures for the destruction of the con- 
tagious element of the disease, and the prevention of the 
extension of the infection ; and in cases of extreme urgency, 
and in the absence of more competent persons, to be pre- 
pared to make such applications of remedies as will accom- 
plish something toward staying the ravages of this terrible 
malady. 

In writing upon the treatment of diphtheria, the author 
has described the methods which he employs in his own 
practice, and which he has found successful in a large number 
of cases, some of which were of the worst form. These 
methods are not presented as original. They have been selected 
from those described in the numerous articles on the subject, 
written by those of the most extensive experience. The 
author is especially indebted to the very exhaustive treatise 
on the subject of diphtheria in " Ziemssen's Cyclopaedia of 

Medicine." 

J. H. K 
Battle Creek, Mich., 

December 23, /SyS. 



I DIPHTHERIA. I* 



HISTORY OF THE DISEASE, 



<£*- 



3TLT is interesting to trace in brief outline the his-. 
^ tory of a malady which has for many years been 
ravaging the homes of thousands in this and other 
countries, sometimes sweeping away whole families 
almost with the rapidity of the terrible plagues of 
the Middle Ages, often decimating the little ones of a 
whole community, and filling the land with a lamen- 
tation almost as pitiful as that described in Holy Writ 
as being heard in ancient Bethlehem when Rachel 
wept for her children slain by the cruel hand of 
Herod. We run no risk in the assertion that not 
more children perished in that heartless massacre than 
often, in our large cities, in a single week fall victims 
to the fell destroyer which we have made the subject 
of this little monograph. 

An Ancient Malady. — The erroneous notion has 
been held by some that diphtheria (pronounced dif-the f - 
ri-a) is distinctly a modern disease. That this is not 



6 DIPHTHERIA. 



the case is clearly shown by reference to the works of 
ancient medical writers in which are found numerous 
very distinctive descriptions of this malady which was 
as fatal in ancient times as at the present day. 

Homer and Hippocrates, who wrote several centu- 
ries before the Christian era, were each familiar with 
this disease under the name of Malum JEgyptiaeum. 
As the ancient name indicates, the disease was by 
early writers supposed to originate in Egypt and Syria. 

An epidemic of diphtheria occurred in Rome a. d. 
880. Holland was visited by the disease in 1557. 
Many other parts of Europe suffered from its rav- 
ages in the two last centuries. The first recorded oc- 
currence of this affection on the American continent 
was in 1771. described by Samuel Bard in 1786. 
In 1856 another very severe epidemic visited this 
country, since which time it has been very common, 
seemingly increasing in virulence from year to year, 
sometimes abating its ravages for a single season, then 
breaking out with redoubled fury and fatality the next. 

Investigation of the Disease. — Up to the year 
1821, little was known of the real nature of the dis- 
ease, notwithstanding the long acquaintance of physi- 
cians with its phenomena. At that time it was thor- 
oughly investigated by Brettonneau. and to the facts 
elicited by his careful study of the history, nature. 
and causes of the disease, the profession have been 
constantly adding new facts of practical interest in its 
prevention and treatment. 

The microscope has been an invaluable aid in this 



NATURE OF THE DISEASE. 



investigation. Indeed, without it, the real nature of 
the disease and its causes could never have been dis- 
covered. Through the aid of this marvelously useful 
little instrument we have now learned nearly the 
whole story of the disease, and the physician, if ac- 
quainted with what is known on the subject, may feel 
himself completely a master of its causes, its history, 
its results, and its proper treatment, although he may 
possibly be unable to so completely command the 
necessary conditions as in all cases successfully to 
control its manifestations. Nevertheless, it is to be 
hoped that the constant improvements made in the 
adaptation of remedies to the diseased conditions 
present in this malady, may ere long secure a far 
greater degree of success than is at present seen in 
the practice of the average practitioner. The author 
of this little work humbly hopes that it may in some 
degree contribute to the attainment of this desirable 
result. 



NATURE OF THE DISEASE, 

The characteristic feature of the disease is a pecul- 
iar membranous formation which makes its appear- 
ance usually upon the fauces or tonsils, and is called 
diphtheritic membrane, from its resemblance to skin, 
which is the signification of the Greek w r ord from 
which the name is derived. 

A Diphtheritic Membrane. — This membrane, or 
rather false membrane, when first formed, is of a 



8 DIPHTHERIA. 



grayish-white color ; very tough, of leathery consist- 
ency, and adheres to the mucous membrane beneath 
it with great tenacity, it being very difficult to tear 
away except in shreds, and then only by laceration of 
the mucous membrane, leaving a bleeding surface. 
The false membrane, in fact, is not formed upon the 
mucous membrane or other tissue where it may occur, 
but in it. At least it sends down numerous rootlets 
which are imbedded between the cells of the tissue 
beneath. 

Where the Membrane Occurs. — The membrane 
is not confined to the fauces. It may occur on any 
portion of the structures of the mouth, the inside of 
the cheeks, the gums, the tongue, the edges of the 
lips, as well as on the tonsils, the uvula, the soft 
palate, and pharynx generally. It may also occur in 
the nasal cavity, either primarily or secondarily, ex- 
tending upward from the fauces. 

We recently treated a case in which the whole back 
portion of the mouth was covered with the diphtheritic 
membrane, which also extended throughout the nasal 
cavity, and even appeared at the edges of the nostrils. 
The exudation may also occur at any other parts of 
the body where there is a union between skin and 
mucous membrane. Even the stomach and intestines 
sometimes become the seat of a diphtheritic membrane. 

Nature of the Membrane. — The exact nature of 
this membrane has been the subject of much experi- 
mental inquiry. Besides being subjected to a most 
careful microscopical inquiry by hundreds of skilled 



XATURE OF THE DISEASE. O, 

microscopists in the Old World as well as the New, 
eager pathologists have submitted it to the test of 
physiological analysis by applying it in various ways 
to lower animals. The results of these inquiries have 
been the establishment of the following facts : — 

1. The active cause of the characteristic feature* 
of diphth.eria are vegetable organisms. 

2. The false membrane is formed by the growth 
of these vegetable parasites in and upon the infected 
mucous membrane, and the vital resistance of the 
tissues to the depredations of the organisms. 

Disease Germs. — The recent application of the 
microscope to medical inquiries has developed the im- 
portant fact that many diseases are occasioned by 
malign attacks upon the vital domain by germs of va- 
rious kinds. It is well known that typhoid fever, 
yellow fever, malarial fevers, and most other febrile 
diseases, are occasioned by the introduction of germs 
into the system ; but it has not in many cases been 
the good fortune of physicians to discover the exact 
character of these microscopical enemies of human 
life. In the case of diphtheria, many most eminent 
physicians and scientists are satisfied that the mis- 
chievous germ has been discovered, after a long- 
continued and pains-taking search. 

The germ causes of diphtheria are very minute or- 
ganisms, being too small to be seen except by the aid 
of a very good microscope. They are so small that a 
row of them an inch long would contain from ten to 
twenty thousand. Singlv. they are too insignificant 



10 DIPHTHERIA. 

to deserve attention except as microscopical curiosi- 
ties ; but when massed together in the countless num- 
bers in which they infest the mucous membrane in 
this disease, they acquire an importance which is often 
terribly great to the victim of their ravages. There 
are tw T o varieties of these parasites, known, respect- 
ively, as micrococcus and bacterium termo ; the 
names are certainly no more formidable than the 
creatures themselves, small though they are. The 
two organisms are always associated, and can be very 
easily studied, with the aid of a good microscope, by 
any one at all familiar with the use of the instrument, 
by examination of the false membrane, freshly taken 
from a patient. 

The Mode of Attack. — We have just taken a 
small piece of diphtheritic membrane from the throat 
of a patient suffering with the disease, and, placing it 
under the microscope with a little mucus from the 
same source, the germs referred to are distinctly visi- 
ble in great numbers, all actively swimming about, 
making the whole microscopic field alive with motion. 
Just so they existed in the throat of the patient a few 
moments ago, where they were vigorously at work, 
insinuating themselves into the mucous membrane, 
prying their way in between the cells, even getting 
into the interior of the cells themselves, depriving 
them of the power to perform their functions, clog- 
ging the blood-vessels, causing irritation of the mem- 
brane, congestion, inflammation, and, as a conse- 
quence, partly, perhaps, as a protection, the pouring 



NATURE OF THE DISEASE. \\ 

out of fibrous matter, which helps to form the false 
membrane, together with the parasitic organisms 
themselves, and the disabled and disintegrated cells 
which they have destroyed. 

Several other kinds of minute organisms are also 
visible, but they are of the sort which are always 
present in mouths not well cleansed, finding access 
from the air, and growing readily and multiplying in 
the fertile soil afforded by food accumulations in the 
cavities of decaying teeth, between the teeth, and 
wherever they can find a lodgment. These are com- 
paratively harmless, though not quite so, if they are 
not such dangerous enemies as the micrococcus and 
bacterium termo, the two cruel Herods which merci- 
lessly slaughter thousands of innocents every year, 
even out-Heroding Herod in their relentless massacre. 
In addition, we happen to find in the specimen just 
now under examination abundance of pus corpuscles, 
which indicates that the patient is on the road to re- 
covery, since nature is pouring out a stream of puru- 
lent matter to wash away the germs, defend the tissues 
from their ravages, and aid in the reparation of the 
injured membrane. 

Infecting the System. — The whole body, outside 
and inside, is inclosed in a sheath of cells called epi- 
thelium, both the skin and the mucous membrane 
being provided with this protection. This living 
wall of cells forms a barrier against the entrance into 
the body of obnoxious elements. Were it not for this 
protection, we should fall an easy prey to the hordes 



12 DIPHTHERIA. 



of unseen but active and voracious enemies which 
swarm the air we breathe, gambol in the water we 
drink, and thickly tenant all the food we eat. To 
most of these emissaries of death and destruction, the 
agents of decomposition and decay, the epithelial 
sheath is an impenetrable barrier ; but the micrococcus 
and the bacterium termo, the diphtheria organisms or 
parasites, possess the power of working themselves 
through this wall of cells, insinuating their infinites- 
imal bodies between the cells, even getting into the 
interior of the living cells and destroying them, thus 
undermining and tearing down the living wall which 
protects the delicate tissues beneath. Thus the 
assaulting germs find an easy road to the lymph chan- 
nels, and quickly infest the glands to which the 
lymphatic vessels lead. By this means, also, they 
soon find their way into the circulation, where they 
multiply with marvelous fecundity, and rapidly in- 
crease to prodigious numbers, attacking the very cita- 
dels of life, and, alas, too often taking by storm the 
strongholds of the vital domain, making an easy 
prey of the organism which but a few hours or days 
before was jubilant with superabundant vital energy. 
An examination of the blood of a person suffering 
severely with diphtheritic infection shows it to be 
filled with the very same organisms found in the false 
membrane, and in the fluids of the mouth of a diph- 
theritic patient. 

Animals Subject to the Ravages of Germs.— 

It is well known that animals are subject to many of 



Mature of the disease. 13 

the same diseases that affect the human family. Es- 
pecially are they subject to diseases which have a 
germ origin. They are remarkably susceptible to in- 
fection by the diphtheria organisms, and rapidly suc- 
cumb to their destructive influence when the germs 
have been introduced into their systems by inocula- 
tion or otherwise. Many of the facts known respect- 
ing this much-dreaded disease have been elicited by 
experiments upon lower animals. Hundreds of dogs, 
rabbits, and other animals have perished of diphthe- 
ritic poisoning artificially produced for the purpose of 
learning the whole truth about this enemy of the hu- 
man race, and thus discovering ways and means for 
staying its ravages and rescuing its victims from im- 
pending destruction. Such experiments may seem 
cruel to some ; but the poor brutes were not tortured 
nor sacrificed to satisfy an idle curiosity, nor to settle 
a point in speculative philosophy. They died martyrs 
— involuntary, it is true — to the cause of humanity, 
in the interests of philanthropic efforts for the* allevia- 
tion of human suffering. Had they been human, 
their names would have been wreathed with laurels as 
noble heroes. 

An Interesting Question. — A question which 
has given rise to much discussion, on account of its 
important bearing as one of practical importance in 
the treatment of this grave malady, is this : — 

Is the primary disorder a local or a general dis- 
ease ? 

There are advocates of both sides of this question, 



14 DIPHTHERIA. 



but the scientific evidence is undoubtedly in favor of 
the view that the primary disorder is wholly a local 
disease. Those who hold this view maintain that the 
germs which cause this disease are received by some 
part of the system, usually the throat, where they 
find lodgment and rapidly develop, penetrating the 
mucous membrane and infecting the general system 
in the manner already described, the part most often 
selected for attack being the throat, not from any 
particular preference of the disease for this part, but 
because the fauces are more exposed to infection by 
the organisms which cause the disease, being received 
during respiration, than are other parts of the body. 

Those who hold the contrary view, regard the diph- 
theritic membrane which appears in the pharynx and 
other parts as a local evidence of a general disease 
which is manifested by the fever, exhaustion of the 
vital energies, and other general symptoms incident 
to the disease. 

The facts which seem to point distinctly to the 
local nature of the disease are chiefly these : — 

1. The local symptoms appear without the general 
symptoms, or, at least, with the fever and other gen- 
eral symptoms so slight as to scarcely merit attention. 

2. In all cases there is more or less disorder of the 
parts on which the membrane first makes its appear- 
ance, from the outset of the disease. 

3. Examinations of the blood show that the con- 
tamination of the system arises from organisms of the 
same character as those found in the diphtheritic 
membrane. 



NATVltfi OF TEE DISEASE. 15 

4. The worst general symptoms follow the devel- 
opment of the local disease, and are usually severe in 
proportion to its severity, that is, in proportion to 
the extent of the false membrane formed. 

5. All the symptoms and results of the disease ap- 
pear in animals to which it is communicated by inocu- 
lating the skin or the mucous membrane with diph- 
theritic matter from a false membrane, which is also 
proportionate in severity to the local manifestation. 

Experience at the bedside continually affords con- 
firmatory evidence of the local character of this dis- 
ease. It is a well-known fact that it is extremely 
liable to appear in a wound, where the surface is de- 
nuded of epithelial covering. This fact has led phy- 
sicians to abandon the use of blisters as a remedy 
in this disease, since the exposed surface is almost 
certain to become the seat of an extensive diphthe- 
ritic membrane, and the formation of a deep slough 
in consequence. This being the case, if the disease 
were of a general character and should attack a per- 
son suffering with a flesh wound of any sort, the local 
manifestations would be almost certain to appear *in 
the wound rather than in other parts which were pro- 
tected by an intact epithelial covering. A case of 
this sort came under our observation about one year 
ago. The patient was a young man of seventeen. 
He enjoyed fair health, but had been a cripple for 
seven years, owing to necrosis of the femur of his 
left leg. After somewhat improving his condition by 
tonic treatment, we operated upon the diseased limb, 



16 DIPHTHERIA. 

removing the lower third of the femur with the ex- 
ception of the epiphesis. The wound was five or six 
inches long, and was deep and gaping. The morn- 
ing following the operation we were greatly surprised 
and alarmed to find a distinct diphtheritic patch in 
the fauces, but none appeared in the wound, either at 
the first or subsequently, and the patient made a 
rapid and complete recovery. 

This case alone, to our mind, is sufficient to estab- 
lish the local character of the disease. Had there 
been a general infection before any local manifestation, 
it would have been quite certain to show itself in the 
wound, where the conditions were favorable, rather 
than in the throat, where there were no special pre- 
disposing conditions. Considering the disease as a 
local disorder producing general symptoms, as do all 
other serious local affections, there is no difficulty in 
accounting for the facts mentioned. 



CAUSES OF DIPHTHERIA. 

It is important to know the causes of this disease, 
for several reasons : — 

1. That if possible they may be avoided. 

2. To secure a better chance for recovery, in cases 
of the disease, by removal of the causes so far as 
possible. 

3. To aid in the selection of the proper remedies 
for the disease. 



CAUSES OF T11K DISEASE. \*J 

A knowledge of causes is important in all classes 
of disease, in order to aid in their intelligent manage- 
ment ; but such knowledge is especially important in 
this disease, for the reasons named, since it is one 
which can only be controlled by attention to causes. 
Medical treatment applied without knowledge of this 
sort is wholly empirical and experimental. No posi- 
tive and constant results can be expected. Every 
attempt at treatment is only a blind experiment on 
the vitality of the patient. This kind of blind, un- 
philosophical management, or more often mismanage- 
ment of the disease, has undoubtedly served to greatly 
increase its percentage of mortality. It is important 
that the disease should be well understood, every- 
where, as by attention to it from the very outset of 
the malady, and the consideration of its causes and of 
its infectious character in its treatment, a large share 
of the mortality arising from it may be saved ; hence 
it will be profitable for us to bestow sufficient space 
upon this part of the subject to secure its thorough 
mastery by any one who is willing to take the pains 
to inform himself on the subject. 

The causes of this disease, like those of most other 
maladies, may be separated into two classes, as fol- 
lows : 1. Exciting causes ; 2. Predisposing causes. 

1. Under the head of exciting causes, the following 
facts are worthy of careful attention : — 

Diphtheria Germs. — The minute organisms 
already described as peculiar to this disease act as the 

Diphtheria. 2 



18 DIPHTHERIA. 



immediate exciting cause in all cases. These germs 
find ready access to the throat and nasal cavity, the 
parts most readily affected by the disease, being taken 
in by the act of respiration. The particular germs 
which are characteristic of this disease are more or 
less common in the air, especially in proximity to de- 
composing matter. It is their enormous numbers 
and extraordinary activity which give to diphtheria 
its dangerous character. 

Diphtheria Contagious. — Since the disease is 
caused by germs, and since these very germs are pro- 
duced in great abundance in the body, and thrown 
off with the breath and other excretions from the 
body, it is evident that it may be communicated from 
one person to another. Clinical experience has veri- 
fied this fact innumerable times. Experiments upon 
animals have also shown that the disease is communi- 
cable by inoculation. The affection is very appropri- 
ately called by one author a " miasmatic, contagious 
disease. ,, On no other hypothesis can observed facts 
be reconciled. The disease is now generally recog- 
nized as contagious, and is treated as such by all en- 
lightened physicians. The certain knowledge of this 
fact is sufficiently useful to well repay all the labor 
and time which have been devoted to the investigation 
of this malady. 

Origin of the Germs. — Diphtheria may very ap- 
propriately be included in the class of diseases latterly 
known as filth diseases, since the parasitic organisms 
essential to its production belong to a class of organ- 



CAUSES OF T7TF DISEASE. ]() 



isms which flourish in organic filth. There can be 
no doubt that in decomposing, putrefying, organic 
matter the germs of this disease find their origin. 
One great source of such poisonous matters may load 
the air of a whole village with the poisonous germs, 
and thus expose to its ravages a whole community at 
once. 

Neglected cess-pools, foul vaults, leaky sewers, damp, 
unventilated cellars, moldy walls, all these and every 
other source of organic decay are the favorite haunts 
of these destructive organisms ; and the only wonder 
is that cases of profound poisoning by these parasitic 
pests are not more common than they are. It is a 
mystery that so many escape. 

Spontaneous Origin of the Disease. —What are 
termed spontaneous cases of the disease, that is, those 
which originated without previous exposure to con- 
tagion from a person suffering from this affection, are 
not uncommon. These cases undoubtedly originate 
from the production of germs by the usual sources of 
disease germs which have already been indicated with 
sufficient definiteness. 

Affinity between Diphtheria and Typhoid and 
other Fevers. — There is some evidence to indicate 
that the cause of typhoid fever and diphtheria may 
not be so very different. It is often observed that 
diphtheria is particularly abundant when typhoid 
fever is especially prevalent. We once observed an 
epidemic of typhoid fever which was followed by a 
number of cases of erysipelas, which was, in turn. 



20 DIPHTHERIA. 



succeeded by an extensive epidemic of diphtheria. 
Whether the germ elements which at least play an 
active part in the development of these diseases are 
precisely the same or not, we may not be able to de- 
cide with certainty ; but we may at least be certain 
that the germ causes of these two formidable diseases 
have a common origin in filth. 

Extraordinary Tenacity of Life. — It is an ob- 
served fact that germs of all sorts, as well as all very 
small organisms, are remarkably tenacious of life. It 
is almost impossible to destroy them either by boiling 
or by freezing, as they will endure both extremes for 
hours without losing their vitality. The germs will 
even retain their virulent properties for months. A 
house in which a family had suffered with diphtheria 
was vacated for several months, and on being again 
occupied, communicated the disease to its new inmates. 

Water, a Medium of Contagion. — Drinking 
water, milk, and even beer, have been proven to be 
the vehicles of typhoid poison in many instances. 
There is good reason to believe that diphtheria may 
be communicated in this manner also, the liquids 
named being contaminated by absorption of the ema- 
nations from prolific sources of germ poisons, or by di- 
rect contamination with the excretions of a diphthe- 
ritic patient. 

Dangerous Kissing. — The common custom, most 
prevalent among the gentler sex, of rather indiscrim- 
inate kissing, bestowing especially frequent favors of 



CAUSES OF THE DISEASE. 21 

this sort upon small children, cannot but be depre- 
cated. There are on record numerous instances ol 
the communication of most loathsome diseases through 
the seemingly harmless medium of a kiss ; and there 
is a special danger respecting this disease which is 
well worthy of consideration. When an epidemic oi 
diphtheria is prevalent, there are numerous cases, es- 
pecially among adults, which are so very trivial in 
their general symptoms that the individual considers 
the difficulty nothing more than a cold, when he is 
really suffering with diphtheria, having distinct patches 
in his throat, and is, unconsciously, sowing broadcast 
the seeds of disease wherever he goes. Such a person 
calls to see a neighbor, and as usual, smothers the 
baby with kisses, and, perhaps, also kisses the larger 
children. What is the result ? Very likely a week 
has not passed before the little one has diphtheria in 
a very severe form, and, possibly, dies. Thus an act 
intended as one of affection, becomes, literally, the 
embrace of death. This hint is w T orth thinking of. 
Life is too valuable to be sacrificed for a kiss. 

Other Means of Contagion. — A few other means 
of contagion which we do not remember having seen 
mentioned are perhaps worthy of attention in a prac- 
tical treatise like this. The disease may unquestion- 
ably be spread very rapidly by the use of a common 
drinking-cup at school or elsewhere. One of the 
worst cases of diphtheria w T e ever saw r was in a little 
child who had taken the disease from a workman em- 
ployed on the premises, by sipping water from the 



22 DIPHTHERIA. 



man's drinking-cup. The man suffered but slightly ; 
but the little boy narrowly escaped without serious 
injury after a very severe illness, with extensive pro- 
duction of the false membrane. Toys and even books 
may also become the medium for communicating the 
disease, as well as articles of clothing, and anything 
that may become infected by the breath or expectora- 
tions of the patient. 

2. Predisposing Causes.— Anything which im- 
pairs the vital functions will predispose to an attack 
of any febrile or other disease. We do not purpose to 
mention here all the numerous causes of impaired 
vitality, but only some of those especially active in 
rendering the system liable to the disease under con- 
sideration. 

Taking Cold. — " Taking cold" is a process very 
difficult to describe exactly, but is so common an oc- 
currence that the phrase is significant to every one. 
In general, when a person has taken a cold there is 
more or less congestion and irritation, if not actual 
inflammation, of the mucous membrane of the pharynx, 
and often of the nasal cavity also. There is also usu- 
ally present an increased secretion of these parts, and 
a tumid condition of the mucous membrane. This 
condition is particularly favorable not only to the 
lodgment and development of the diphtheria germs, 
but to the development of the accompanying inflam- 
mation. 

Chronic Catarrh. — Chronic inflammation or ca- 
tarrh of the pharynx, as well as nasal catarrh, is also 



C A USES OF THE DISEASE. 23 

a powerful predisposing cause of diphtheritic inflam- 
mation of those parts. When the mucous membrane 
is already affected by an inflammatory process, the 
presence of the diphtheria organisms is all that is re- 
quired to convert the morbid process into a diphtheritic 
inflammation. Consequently, those who are thus suf- 
fering should be exceedingly careful to avoid any sort 
of exposure to infection from the disease. Persons 
who have been subject to catarrh usually find the dif- 
ficulty greatly increased after an attack of diphtheria. 

Insanitary Conditions, — Insanitary conditions, 
by impairing the vital forces, and thus diminishing 
the vital resistance of the tissues, will produce a strong 
predisposition to diphtheria. As already shown, all 
sources of decay may also be sources of diphtheria 
poisoning, so that insanitary conditions are both di- 
rectly and indirectly productive of this dangerous mal- 
ady. This fact is well worthy of repeated emphasis. 

Age. — Children under ten years of age show a 
marked susceptibility to this disease. Between th€ 
ages of two and four years the susceptibility is great- 
est. Children under one year of age are not likely 
to have the disease. Very young children seem to be 
almost wholly protected against it by their infancy. 
Children are not only the most liable to take the dis- 
ease, but they are likely to suffer the most severely. 
Adults, except in cases of extreme old age, suffer 
much less from the most serious results of the disease 
on account of greater size of the larynx. In children 
the larvnx is so small that suffocation is imminent 



24 DIPHTHERIA. 



when the throat becomes affected, while adults may 
suffer the same amount of infection and invasion of 
the throat and larynx without any serious interrup- 
tion of respiration. This is one cause for the greater 
fatality of the disease in children. 

Weather Not a Special Cause. — The observa- 
tions thus far made upon the disease tend to show 
that, contrary to the commonly received opinion, the 
prevalence of the disease is little affected by the season 
of the year, or by atmospheric or other meteorological 
changes. The disease is often more prevalent in the 
cooler seasons of the year than in the summer, but 
probably this fact is wholly due to the increase of pre- 
disposing influences of other sorts at those times, as 
increased frequency of colds and nasal and pharyngeal 
catarrhs ; less free circulation of air in dwelling- 
houses greatly increasing the virulence of the poison 
wherever it may chance to be at work, and similar 
incidental causes. The disease has been known, in 
many instances, to extend its ravages in certain locali- 
ties as widely and as fatally during the heat of sum- 
mer as at any other season of the year. 

There is no evidence that ozone or any other natu- 
ral constituent of the atmosphere is either an exciting 
or predisposing cause of this disease, as has been sup- 
posed by some. 



PRE VENT ION. 25 



HOW TO PREVENT DIPHTHERIA, 



We have now come to the practical part of this 
subject, to which all the foregoing statements of facts 
and theories have been introductory and preparatory. 
The prophylaxis or prevention of a disease so serious 
in its character, in its results, so fatal in its tenden- 
cies, so tenacious in its hold upon its victims, and so 
prone to seize upon the frailest and most helpless 
members of the household, is a matter of paramount 
importance in the consideration of this subject. It 
has been well said with reference to disease in general 
that " prevention is better than cure." There can be 
no question of the truth of this medical maxim with 
reference to this disease at least. Its fatality is so 
great, its infecting poison is so virulent in its charac- 
ter and so tenacious of life, and the results of the 
disease are so serious and often so permanent, even in 
the mildest cases, that it is of the greatest importance 
that active, energetic, and effective measures should 
be adopted for its limitation and prevention, if med- 
ical science or experience affords any information re- 
specting the proper methods for securing so desirable 
results. 

The prophylactic measures to be adopted are not 
numerous nor difficult of application ; on the con- 
trary, they are few and simple, 'and if thoroughly 
employed, are remarkably effective. 



26 DIPH T HE RIA. 



Avoidances of Causes. — Evidently the first in- 
dication for prevention would be entire avoidance of 
all the exciting and predisposing causes of the disease. 
Avoidance of the exciting causes will of course secure 
entire immunity from the disease. Avoidance of the 
predisposing causes will greatly increase the chances 
for escape, even when the person is necessarily ex- 
posed to the specific poison which is the most active 
agent in its production. The recapitulation of all the 
facts mentioned under these two heads is unnecessary, 
as the reader can readily refer to the previous sections 
to refresh his memory if necessary. 

Avoid Taking Cold. — This predisposing cause is 
so active an agent in augmenting the prevalence of 
diphtheria by greatly increasing the susceptibility to 
infection that it is worthy of separate mention, al- 
though already covered by the remarks in the pre- 
ceding paragraph. As before explained, catarrh of 
the pharynx and of the nasal cavity renders the mu- 
cous membrane of those parts much more susceptible 
to the malign influence of the parasitic organisms 
which constitute the contagium of this disease. The 
mucous membrane is rendered in some degree defense- 
less against the poison of the disease, and its con- 
gested state renders it a most fertile soil for the 
development and dissemination through the system of 
the minute organisms which are the agents of mis- 
chief in this disease. If diphtheria is prevalent in a 
neighborhood, parents should exercise the greatest 
care to keep their children from taking cold. This 



PREVEXTIOX. 27 

will not be successfully accomplished by keeping them 
confined in close rooms, but by keeping the skin 
active by frequent bathing, and the circulation vigor- 
ous and well balanced by proper clothing, warm under- 
garments, thick shoes and stockings, etc. It is of es- 
pecial importance that the limbs should be thoroughly 
clad with warm woolen garments, and that the feet 
should be kept dry and warm. It is not necessary 
that shoes or boots should admit water to cause cold- 
ness and dampness of the feet. If they are simply 
wet on the outside, the feet will be chilled by the 
evaporation, and will often become damp by perspira- 
tion, and the person is very liable to contract a cold. 
Mothers should exercise especial care for their chil- 
dren's feet if they wish them to avoid taking cold. 
Overshoes should be worn on cold, damp days, but 
should be removed as soon as the child enters the 
house. The feet are greatly injured by the constant 
wearing of rubber or other impervious covering. What 
is true of overshoes is equally true of rubbers. They 
should never be worn in the house. 

Ventilation. — A person suffering with diphtheria 
constantly sends out with his breath volumes of the 
disease-producing organisms which are preying upon 
his system. Unless the air in the sick room is 
constantly renewed, the whole atmosphere soon be- 
comes saturated with contagious matter, and any one 
coming into the room is placed under the most favor- 
able conditions possible for becoming infected. By 
thorough and constant ventilation, the verms are car- 



28 DIPHTHERIA. 



ried away as rapidly as they are generated, and thus 
the danger of contagion is greatly lessened. Thorough 
ventilation is also a most important measure of treat- 
ment, as well as prevention. If the air is charged 
with germs, the system of the patient will be contin- 
ually reinfected as he breathes over and over again 
the poison-laden atmosphere. 

If the means of ventilation are not such as to allow 
of a constant change of air without injury to the pa- 
tient by the production of strong draughts, the follow- . 
ing plan may be adopted : Secure as nearly the right 
conditions for a constant supply of fresh air as is pos- 
sible under the circumstances. Then, to completely 
renovate the air of the sick room, at least once in half 
an hour, open the doors and windows widely for four 
or five minutes. As a precaution against any possi- 
ble injury, the fire may be urged a little more briskly 
just previous to the airing and for a few minutes after. 
The patient may be protected from draughts by an 
extra covering at the same time. 

But the most desirable plan of all is to provide the 
sick room with a good ventilator, which can be done 
very easily and at small expense. (See advertisement 
of ventilators at the conclusion of this work.) 

Isolation of the Patient. — As soon as it is dis- 
covered that a member of a family is affected with 
diphtheria, the patient should be placed in a room 
apart from other members of the family, and only 
those necessarily employed in administering to the 
wants of the sick one should be allowed to frequent 



PRE VEXTION. 29 

the room. The younger members of the family, es- 
pecially, should be entirely excluded from the room. 
Careful attention to this rule would often prevent the 
extension of this dangerous malady to other members 
of the family. Visitors who call should rarely be ad- 
mitted to the sick room, as they may not only con- 
tract the disease themselves, but become the vehicles 
of the contagium to others. Isolation of patients is 
not always pleasant, either to patients or to friends ; 
but in case of contagious disease it is a matter of great 
importance, and a duty to society which cannot be 
neglected without injury to some one. It is well that 
our State Boards of Health and other sanitary officials 
are becoming awakened upon this subject. The State 
Board of Health of Michigan has published a circu- 
lar on the restriction and prevention of diphtheria 
which is so concise, practical, and complete, that we 
have reproduced the greater portion of it at the con- 
clusion of this work. 

Preventive Treatment. — In addition to the sev- 
eral particulars mentioned, we are convinced from re- 
peated observations that some measures of treatment 
can be adopted which are of great service in protect- 
ing an individual against this disease. 

In the first place, it is always important that the 
excretory organs, especially the liver and the skin, 
should be kept active by frequent bathing and abun- 
dant exercise in the open air. But the especially im- 
portant measure of treatment to be adopted is of a local 
character, consisting of disinfection of the mouth. As 



30 DIPHTHERIA. 



before observed, it is through the air-passages that 
infection of the system occurs. The fauces are 
almost always the first point of attack. There are 
many well-known agents w T hich will destroy the germs 
of diphtheria as well as other classes of germs, some 
of which may be utilized in treatment. All disinfect- 
ants are agents of this sort. Permanganate of potash 
and chlorine are especially useful for this purpose. 
Both of these substances may be used to great ad- 
vantage as gargles by those who are exposed to diph- 
theria. The permanganate dissolves very readily in 
water, and should be used in a solution sufficiently 
strong to have a deep purple color. Chlorine may be 
employed in several ways, as follows : 1. A solution 
of fresh chloride of lime as strong as can be borne in 
the mouth ; 2. A strong solution of common salt. A 
saturated solution is required ; 3. A solution of chlo- 
rinated soda, in the proportion of one part of the solu- 
tion, as found at the drug stores, to two or three of 
water, according to the strength of the solution. The 
preparation last mentioned is by far the best. We 
use it constantly for this purpose, and, apparently, 
with excellent success. 

Gargles, to be effective, must be employed thor- 
oughly. Their object is, of course, to destroy the 
germs which accumulate in the throat from the air, 
before they have time to set up a morbid process in 
the fauces and get into the blood. If this could be 
done constantly, so that no germs w^ould escape alive, 
the protection would be complete. The treatment is 



DBSCMIF TlOJf. 31 

necessarily intermittent. Nevertheless, if a gargle. 
such as described, is used very thoroughly every half 
hour, the chances of taking the disease are greatly 
decreased. 

This remedv is so simple it should be thoroughly 
employed by all who are necessarily exposed to diph- 
theria even in its mild form. It is true that the viru- 
lence of the poison is usually proportionate to the 
intensity of the disease in the case from which it is 
derived ; yet it not infrequently happens that a very 
malignant case results from infection by a case which 
was in all respects very mild in character. Children 
who cannot use the gargle successfully should have it 
applied with a swab, or syringe. 



DESCRIPTION OF THE DISEASE, 

Some medical authors devote considerable space to 
descriptions of this disease in all its numerous phases. 
but we shall only attempt, in the brief space at our 
command, to sketch the chief features of the malady, 
such as may be intelligible and serviceable to the 
common observer, for whom this work is chiefly pre- 
pared. 

The local disease which is the primary lesion in 
this affection varies so greatly in intensity and in ex- 
tent, the general symptoms growing out of the local 
morbid process being modified accordingly, as well as 
by the age and other conditions of the patient, that 



32 DIPHTHERIA. 



different cases of the disease in the same family may 
differ so greatly as to be hardly recognizable as iden- 
tical in character. In one, the local and general 
disturbance will be so slight that without examination 
of the fauces and discovery of the membrane the pa- 
tient will think himself merely suffering from a u sore 
throat" due to a cold. Such cases as these usually sow 
broadcast the seeds of the disease, its nature not being 
recognized, and no precautions considered necessary. 
In another, the diseased process may acquire an 
intensity and malignancy only equaled in the fatality 
of its effects by the terrible plagues which in past 
times have swept over and decimated the great centers 
of civilization in the Old World. 

Different Forms of the Disease.— These vary- 
ing manifestations of different degrees of the same 
morbid process have acquired various names as inde- 
pendent diseases ; but it is quite evident that they 
are only phases of the same malady, and require, in 
treatment, the application of the same general princi- 
ples. In order to be able to recognize the disease, 
it is important, however, to understand the several 
phases which it manifests ; hence we shall observe 
the following classification of the disease : 1. Ca- 
tarrhal ; 2. Croupous; 3. Malignant. 

Period of Incubation. — The period of incuba- 
tion of the disease is, according to most authorities, 
two to eight days. The average is two or three days. 
In some cases, as many as ten or twelve days have 
been known to elapse after exposure before the ap- 



DESCRIPTION. 33 

pearance of the characteristic symptoms of the affec- 
tion. 

An important fact to be recollected is that one at- 
tack of diphtheria is no protection against subsequent 
attacks. Indeed, a person who has had diphtheria is 
even more susceptible to the poison, and more liable 
to infection, than if he had not suffered from the dis- 
ease 

Catarrhal Diphtheria. — This, the mildest, is 
also the most common form of the disease. It begins 
without warning, there being no premonitory symp- 
toms. The fever, if there is any present, is very 
slight. The patient usually complains of a feeling of 
malaise, dryness in the throat, with a slight pain in 
the part, which is increased in swallowing. The 
glands about the throat swell somewhat, and are a 
little tender on pressure. 

Occasionally more marked symptoms appear, the 
fever being more intense, the temperature, as indi- 
cated by the thermometer, rising three or four degrees 
above that of the body in health. The skin is dry 
and hot, the face flushed, the pulse frequent and full. 
There are usually, also, heaviness of the head, stu- 
pidity, great thirst, and much pain induced by swal- 
lowing. The stomach is also frequently disturbed, 
nausea and vomiting often occurring. The latter 
symptoms also occur, in some cases, at the outset of 
the disease. 

In this form of the disease the infection is so slight 

Diphtheria. 3 



34 DIPHTHERIA. 

that all the symptoms named usually disappear almost 
altogether in a day or two, often sooner. 

Many of these cases pass through their entire 
course without their real character being suspected. 
If, however, an early examination of the patient is 
made, it will be seen at first, upon inspection of the 
mouth and fauces, that the mucous membrane has 
an unnatural, vivid red color, and is considerably swol- 
len in certain places, from the intense congestion. 
Only one tonsil may be affected, or both ; or the soft 
palate, the uvula, the back part of the pharynx, be- 
hind the uvula, one part, or all, may be involved in 
the disease. The affected tonsil usually appears con- 
siderably swollen, projecting into the cavity of the 
throat. After a few hours, small grayish-white or 
whitish-yellow spots, varying in size from that of a 
pin head to a very small pea, make their appearance. 
The spots are usually arranged in a few delicate, ring- 
like groups. They may be quite distinct, or may run 
together. 

In most cases of this form of the disease the exu- 
dation described is confined to one tonsil ; no exten- 
sive false membranes being formed. 

After the first twenty-four hours, the patches which 
appear begin to assume a dirty gray color. The mu- 
cous membrane rapidly becomes normal again, its un- 
natural redness disappearing, so that after tw r o or 
three days the patches may be seen clinging to a 
membrane in other respects perfectly healthy. On 
the third or fourth day, sometimes as late as the fifth 



DESC BIT TIOX. 35 



or sixth, the patches already loosened from the mu- 
cous membrane become wholly detached, and the 
membrane is left in its former condition, there re- 
maining no trace of the late disease. 

Croupous Diphtheria. — But the disease does not 
alwavs terminate so quickly and so favorably. In- 
stead of progressing steadily toward a speedy resolu- 
tion, the morbid processes continue about the same as 
on the first day. for several days. On the fourth, or.. 
possibly, as late as the sixth day, the temperature sud- 
denly rises to 103 c or 104° F. The pulse also indi- 
cates a high fever, ranging from 120 to X 8 C> beats 
per minute. The head is hot and the mind confused. 
There is great increase of thirst, and dryness and 
pain in the throat. The diphtheritic membrane ex- 
tends very rapidly, the spots running together, form- 
ing a large whitish patch equal in size to a silver 
quarter dollar. Indeed, in a short time a large por- 
tion of the mouth and fauces may be covered. This 
is the croupous form of the disease. 

Sometimes the croupous form begins with chilly 
sensations — not a true chill — which are followed by 
intense fever, the temperature rising as high as 105°. 
or over. The patient may suffer from nausea and 
repeated vomiting, and usually complains of pain in 
the head. neck, and loins, weakness in the limbs, and 
drowsiness. Children are inclined to sleep during the 
day time even more than is natural, but are restless 
at night, having some delirium, with convulsive twitch- 
ings of the limbs, and occasionally- even an actual 



36 DIPHTHERIA. 



convulsion occurs. All the symptoms described as 
occurring in the catarrhal form of the disease are in- 
tensified in this, and succeed each other with much 
greater rapidity. When the disease assumes the 
croupous form from the outset, the local symptoms are 
much more rapidly developed, and the membrane very 
quickly becomes very thick and of a leathery consist- 
ency. If the false membrane is torn off, it comes 
away in shreds, and is quickly replaced by another. 

The fever usually increases in proportion to the in- 
tensity of the local disease. After a few days, it di- 
minishes. At this time, if nature has not begun a 
reparatory process, the patient is very liable to sink 
in collapse and die, even in a few hours. At this 
point the disease often assumes the malignant form. 
Unless the mouth is kept perfectly cleansed by very 
frequent rinsing, the breath of the patient at this time 
becomes exceedingly offensive from the decomposition 
of the mucus, exudation, false membrane, etc., which 
rapidly accumulate and become putrescent in the 
mouth. 

At this stage, the kidneys often become affected, 
which is shown by the appearance of albumen in the 
urine. This is an indication of the general infection of 
the whole system, and is a grave symptom, since the 
condition may continue for months if the patient re- 
covers. 

If the local disease does not extend much beyond 
the fauces, the patient usually recovers rapidly. But in 
severe cases, this is not the termination. The disease 



D£S G R IP TIOX. 37 

gradually extends along the mucous membrane to 
other parts of the air-passages, upward into the nasal 
cavity, the Eustachian canals, and even to the ear, 
and downward into the larynx, trachea, and bronchi. 
The patient may die of the intense poisoning of the 
whole system. Even gangrenous sloughing may oc- 
cur, which is almost certain to be followed by a fatal 
result. 

Sometimes a relapse occurs after recovery seems to 
be well established, but it is not commonly followed 
by a fatal result. The duration of this form of the 
disease is usually two or three weeks, being occasion- 
ally as brief as ten or twelve days. When recovery 
is to take place, improvement usually begins as early 
as the beginning of the second week, when the fever 
frequently disappears very suddenly, notwithstanding 
the presence of large patches of membrane. The 
tongue, which has been densely coated, clears, appe- 
tite returns, the patient sleeps well, the kidneys act 
more freely, and weakness seems to be the principal 
difficulty remaining. The membranes may disappear 
in two or three days, or may persist for several weeks. 

Diphtheria of the Nose.— The invasion of the 
nose is indicated by a sensation of dryness and a 
stuffed feeling which interferes with respiration. A 
discharge soon appears which is much like the dis- 
charge of the acute stage of nasal catarrh, becoming 
foul and bloody as the disease progresses. Hemor- 
rhage from the nose sometimes occurs. When the dis- 
ease extends into the Eustachian tubes, the invasion 



38 DIPHTHERIA. 



is indicated by a ringing, buzzing, or roaring sound 
in the ears. Severe pain is experienced in swallow- 
ing, and the hearing is diminished. A false mem- 
brane is in these cases formed in the tympanum, cover- 
ing the ossicles. The final end is in perforation of the 
drum, and a discharge of pus. 

Sometimes the extension of the disease to the nose 
is indicated by reddening of the skin of the nose, or 
oedematous swelling, with remarkable pallor and a 
glistening appearance. A slight extension of the dis- 
ease to the nose may end in recovery ; but if the sur- 
face covered is extensive, death is very liable to occur. 
This form of the disease usually terminates, in some 
way, in a few days, too often fatally. The decompos- 
ing membranes in the nasal cavity cause extensive 
ulcerations, and even destruction of the cartilages and 
bones of the nose, and the patient dies of general 
poisoning from absorption of the decomposing matter 
into the blood. 

Diphtheria of the Larynx. — In bad cases of 
croupous diphtheria, the membrane extends low down 
in the pharynx, and then invades the larynx. Some- 
times, also, the larynx becomes affected when the 
patches in the throat are quite small. It is even pos- 
sible that the membrane may make its first appear- 
ance in the larynx. Sometimes the lips are first af- 
fected, then the larynx, skipping the throat. But 
the local affection of the larynx usually occurs by ex- 
tension of the disease from the throat on the third or 



DESCRIPTION. 39 



fourth day of the disease, sometimes even late as the 
latter part of the second week. 

In diphtheria of the larynx the special danger aris- 
ing from the disease in this part is greater the younger 
the patient, since the smaller the larynx, the more 
imminent the danger from suffocation. Patients de- 
bilitated by age or otherwise, are also likely to suffer 
fatally. 

In adults, there are no special symptoms which 
immediately indicate the extension of the disease to 
the larynx, except a general increase of the fever and 
exaggeration of the symptoms arising from disease in 
the fauces ; but shortly there appears evidence of in- 
flammation and some degree of obstruction in the 
larynx, in the change of voice, hoarseness, a dry 
cough, which is without resonance, whistling with the 
drawing in of the breath, sometimes great obstruction 
to respiration from the inflammation and swelling of 
the vocal cords. In adults, when death occurs it is 
usually from general poisoning ; or, it may occur in 
consequence of the obstruction caused by a separation 
of the membranes, which occasionally fall down into 
the larynx instead of being expectorated, and so cause 
obstruction and suffocation as any other foreign body 
in the same locality might do. 

In Children the symptoms mentioned as occurring 
in adults are much more marked, and many others are 
also present. The peculiar characteristics of the dis- 
ease in this location are whistling respiration, and a 
very peculiar, fiat, barking sound, without resonance, 



40 DIPHTHERIA. 



which is known as " croupy cough," the same symp- 
tom being present in true croup. Loss of voice and 
the other usual symptoms of croup are present. The 
epiglottis is usually swollen to double the natural size. 
In bad cases the face presents the cyanotic or bluish 
appearance characteristic of partial suffocation. 

In this form the disease usually runs its course in 
two to eight days, though it may continue as long as 
two weeks. It is not impossible for recovery to take 
place in this disease, but death usually results in con- 
sequence of suffocation from spasm of the glottis ; ob- 
struction of air-passages by secretion and false mem- 
brane ; blood poisoning ; pneumonia of the lungs ; or 
oedema of the lungs or glottis. Any one of these 
causes is sufficient to produce a fatal result, but in 
most cases several or all are combined. 

When recovery does occur, it is by the separation 
and expectoration of the false membrane, which some- 
times is coughed up entire, presenting an exact cast of 
the larynx. Hoarseness continues for some time after 
recovery in most cases. 

Malignant Diphtheria. — As previously men- 
tioned, in bad cases poisoning of the blood may occur 
from absorption of the products of the decomposition 
of the false membrane. Sloughing of the tissues of 
the affected parts is also an occurrence in the 
worst cases of the croupous form of the disease. 
The symptoms of extreme prostration and of profound 
poisoning of the system, as well as the great fatality 
in these cases, well entitles the disease in this form to 



DESCRIPTION. 41 

be called malignant. The terrible "black vomit" 
and the worst form of yellow fever are scarcely more 
malignant in their symptoms or results. 

Blood poisoning sometimes occurs as early as the 
second day, but more often later. After the mem- 
brane appears, the breath gradually becomes foul, 
from the decomposition of the membrane, which be- 
comes brittle and soft, and very offensive. The glands 
become greatly swollen, so that the face and neck ap- 
pear as one. The skin about the throat is smooth 
and shiny, and the parts hard, and doughy. The 
pulse becomes weak and slow, sometimes not more 
than fifty or sixty, even as low as forty. The tem- 
perature sinks one or two degrees below the normal 
temperature. The patient often dies suddenly from 
collapse, with failure of the heart. 

When the blood is once thoroughly poisoned, re- 
covery is extremely rare. If improvement does occur, 
it is indicated by a cessation of the discharge from 
the nose, a gradual clearing of the fauces, an increase 
in the pulse, and a rise in the temperature, indicating 
a revival of the vital forces. The patient will begin 
to exhibit symptoms of slight fever again. The sod- 
den appearance of the face disappears, and the swell- 
ing diminishes. The recovery is very slow indeed, 
occupying weeks. 

With the occurrence of gangrenous sloughing of the 
fauces, collapse rapidly comes on. This occurrence is 
indicated by small pulse, cold skin, with the develop- 
ment of erysipelas on portions of the skin, involuntary 



42 DIPHTHERIA. 



discharges from the bowels, inflammation of internal 
organs, shortly followed by death. Recovery of cases 
in which gangrene occurs is extremely rare. 

Paralysis and Other After Results. — Secon- 
dary affections of various sorts may follow any 
form of diphtheritic disease. The most common of 
these is paralysis. Paralysis of the soft palate and 
pharynx is the most frequent ; but the disease may 
involve any part or the whole of the muscular system. 
This affection usually comes on after the local disease 
is cured, even as late as the fifth or sixth week. It 
usually appears in the second or third week, begin- 
ning so insidiously as to be scarcely noticeable, and 
gradually increasing until fully developed. The soft 
palate is first affected. The uvula hangs down, 
making it impossible to give the open sound of the 
vowel a. If the paralysis is of one side only, the 
uvula will be drawn over toward the healthy side. 
The patient finds difficulty in articulation, in swallow- 
ing, and in expectoration. The speech is thin and 
nasal. The sounds of syllables run into each other, 
being sometimes almost unintelligible. The patient 
will sometimes complain of liquids getting into the 
nasal cavity in drinking. 

Next, the vision may be affected. Patient cannot 
read fine print as before, and has flashes of light be- 
fore his eyes, which are easily fatigued. Double vis- 
ion, squinting, and vertigo, are also common symp- 
toms. 

Paralysis of the muscles of the upper and lower 



TREATMENT, 43 



extremities, of the larynx, of the face, the eye, the 
neck, trunk, and diaphragm, and of other parts also, 
occur in many instances, beginning a week or two 
after convalescence begins. 



TREATMENT. 

Thus far, the treatment of this disease has not 
been very satisfactory. The history of the various 
epidemics recorded shows a mortality of one in every 
two and one-half cases, or forty per cent In some 
epidemics a rate of mortality as high as sixty and even 
seventy-five per cent, has been reached. This makes 
the disease even more to be dreaded than small-pox 
or cholera. Even yellow fever scarcely exceeds it 
in fatality. 

Notwithstanding the discouraging outlook for the 
treatment of this disease, there is reason to hope that 
the adoption of improved methods of treatment may 
greatly lessen its present fatality. Constant improve- 
ments are being made in the therapeutics of this as 
well as other diseases ; and it is to be hoped that in 
the near future its terrible ravages will be stayed by a 
better application of remedies in its management. 
The plan of treatment which we have to recommend 
is based on practical experience with a large number 
of cases. To our personal knowledge it has been em- 
ployed in more than three hundred cases with uniform 
success, no death occurring when the treatment was 
applied soon after the outset of the disease, and per- 



44 DIPHTHERIA. 

severingly employed. We have ourselves observed its 
efficiency in the treatment of fully one hundred cases, 
and have never seen a patient lost which was thus 
treated. Yet it is not claimed that this or any other 
plan is a specific. We expect sometime to meet with 
a fatal case, since no method of treatment can be in- 
fallible ; but we are thoroughly convinced that a great 
improvement can be made on the ordinary mode of 
treating this disease. 

Indication for Treatment. — In the treatment 
of any disease that plan will be found the most suc- 
cessful which is based upon a study of nature. Every 
acute disease must be considered as an effort of nature 
to make right some wrong condition ; to remove some 
obnoxious element ; to restore the system to a normal 
condition. What the physician should do is to watch 
the indications of nature, and assist her in her work 
by supplying proper conditions, by removing causes, 
both exciting and predisposing, by removing obstacles 
so far as may be done by artificial means. Thus nat- 
ure may be aided in her work. Too often the efforts 
of the physician are such as to thwart the purposes 
of nature, and to render ineffective the vis medicatrix 
naturce, which with a proper opportunity might have 
secured the patient's recovery. 

The physician should ever exercise the greatest care 
that he does nothing to hinder the efforts of nature. 
Better do nothing than to do the wrong thing. Firing 
random shots is a most unsafe practice in treating 
disease. Better by far trust wholly to nature with 



TREATMENT. 45 



the aid of good nursing than to run any risk of plac- 
ing hindrances in her way. We have no doubt that 
at least a portion of the fatality of the disease under 
consideration has been due to injudicious treatment, 
the employment of improper remedies, and neglect of 
the proper measures. 

The indications to be met by remedies in the treat- 
ment of diphtheria may be classified as follows, ac- 
cording as they are either local or general in charac- 
ter : — 

1. Local indications. 

(a) To subdue local inflammation and mitigate its 
results. 

(b) To prevent general poisoning of the system. 

2. Cieneral indications. 

(a) To control the general fever. 

(b) To sustain the strength of the patient. 

LOCAL TELA TMLNT. 

As already observed, diphtheria is primarily a local 
disease. This being the case, its local treatment be- 
comes a matter of the greatest consequence. Indeed, 
this portion of the treatment should receive first at- 
tention. This fact has been long recognized by one 
class of physicians, those who have believed the dis- 
ease to be essentially local in character ; and a great 
variety of remedies have been employed. Prominent 
among these has been the application of caustics of 
various sorts to the throat. Nitrate of silver, nitric 
acid, hydrochloric acid, iodine, caustic potash, pure 



46 DIPHTHERIA. 



carbolic acid, and various other caustics have been 
thus employed, but none so frequently or so exten- 
sively as the first named. Nitrate of silver is still so 
largely used that it may be well to give it a brief con- 
sideration. 

The advantages from its use are supposed to be, de- 
struction of the disease germs and of the false 
membrane, and the conversion of the diphtheritic 
inflammation into an ordinary inflammatory process. 
The objections to its use are chiefly the following : — 

1. It accomplishes very imperfectly the destruction 
of the germs, since all cannot be reached, even by 
repeated applications. 

2. It does not control nor greatly modify the 
diphtheritic inflammation. 

3. By the irritation which it occasions, it most 
frequently increases the inflammation, sometimes 
enormously, and, there is good reason to believe, 
fatally. 

4. By the destruction of the epithelium, it facili- 
tates the absorption of the germs into the blood, and 
so increases the general poisoning. 

5. It is a severe remedy, and greatly adds to the 
patient's discomfort. 

6. Its use has not lessened the average fatality of 
the disease. 

7. The most experienced and scientific physicians 
have abandoned its use, and condemned it in strong 
terms, as the following citations will show. 



TREATMENT. 47 



After dwelling at some length upon the evil results 
of cauterization, Oertel remarks as follows : — 

" There can be no doubt, then, that the unfavorable 
results which have been obtained on all sides by 
cauterizations, more or less energetically practiced, 
must put a stop to this procedure, even if, in its 
stead, we should be obliged to resort to its opposite, 
the purely expectant and symptomatic treatment." * 

Another author, eminent both as a teacher and as 
a practitioner of medicine, says : — 

" A large proportion, if not the great majority, of 
the practitioners of this country have been led to dis- 
continue the cauterizing and irritating topical appli- 
cations which have been heretofore in vogue." f 

Numerous other equally eminent names might be 
cited as opposed to the use of caustics in this malady. 
Among others, Profs. Janeway and Lusk, of Bellvue 
Hospital Medical College, New York. 

Let us now consider in detail the remedies to be 
applied in meeting the indications for local treatment. 

To control the local inflammation and mitigate its 
results. 

In order to accomplish this, several results must be 
attained, which we will mention in detail, describing 
also the remedial measures most likely to secure the 
desired results. 

1. The disease must, if possible, be restricted in its 

* "Ziemssen's Cyclopedia of the Practice of Medicine," vol. i. 
p. 673. 

t "Practice of Medicine," by Austin Flint. 



48 DITITTHERIA. 

progress, and confined to the form which it first as- 
sumes. As before observed, it is very likely to pass 
from a mild into a malignant form when allowed to 
take its natural course. Hence the importance of 
early and energetic treatment. Let no time be lost. 

There are two classes of remedies useful for this 
purpose. One destroys the germs, the other limits 
their development. If thoroughly and persistently 
used, the employment of these agents will be attended 
with results quite astounding to those who have never 
before observed their effects. The first class com- 
prises nearly all active 

Disinfectants. — All agents which are destructive 
to germs when used in a form which will not destroy 
the living tissues, are useful for this purpose ; but the 
best preparations are solutions of chlorine, or of some 
of its compounds, permanganate of potash, and 
carbolic acid. Strong alcohol has proven very effect- 
ive in many cases. These solutions must be used 
thoroughly and often as gargles. At least twice an 
hour the throat and mouth must be well rinsed. If 
the patient is too young to gargle well, or if the pos- 
terior part of the pharynx is affected, the disinfecting 
lotion must be applied with a swab or syringe. A 
swab can be easily made by tying a small soft sponge 
or a strip of muslin to the end of a small stick or a 
lead pencil. In case the nasal cavity is invaded, the 
solution must be passed through the nose by a syringe. 
The following directions for the preparation of solu- 
tions which we have found to give exceedingly satis- 



TEE A TM EXT. 41* 



factory results may be useful to the unprofessional 
reader : — 

\ on*, (a) One parr of a freshly pre- 
pared solution of chlorine gas. or ehlorii la, in 
three to five parts of pure water, according to the 
strength of the solution and the sensibility of the af- 
fected parts. Keep tightly corked, and wrap the 
bottle with a dark cloth or paper. 

(b) In a pin: I >ttle place : tea-spoonful of chlorate 
of potash. Drop in a half-teaspoonful of muriatic a 
cork the bottle quickly, and shake it gently in such 
a way as to bring the acid well in contact with the 
crystals. A greenish-yellow gas will appear in the 
bottle. After allowing the bottle to remain closed for 
ten or fifteen minutes, remove the stopper and pour in 
quickly half a teacupful of water. Stopper the bottle 
again immediately and shake four or five minutes. 
Repeat the process until the bottle is two-thirds full. 
Use as strong as patient can bear without causing 
irritation of the mucous membrane. 

(c) Dissolve in a half pint of equal quantities of 
vinegar and water two heaping teaspoonfbls of com- 
mon salt. Use very freely. 

Permangana:-: of P:~as ] <. one of the most useful 
of all disinfectants, is a good remedy in this disease. 
Dissolve in a pint of pure water, in a glass vessel, one- 
half dram of permanganate of potash or soda* Use 
of nil ith an equal quantity >f water. 

Diphtheria. 4 



50 DIPHTHERIA. 



This solution will stain clothing upon which it happens 
to fall, as well as the skin. The stains are easily re- 
moved, however, by a weak solution of oxalic acid. 

Carbolic Acid. In a solution of one part of glycer- 
ine to three of water, dissolve pure carbolic acid in 
proportion of three to five drops to the ounce. We 
sometimes employ equal quantities of water and wine 
instead of the glycerine solution. To some patients 
the odor of carbolic acid is very disagreeable. For 
such, a solution containing an equal quantity of the 
oil of thyme may be tried. 

If these solutions are carefully prepared and faith- 
fully used from the outset of the disease, the results 
will be exceedingly satisfactory. They can be obtained 
of any druggist, and most of them can be readily 
prepared at home if the materials are at hand. It is 
important that every family should have the materials 
for at least one or two of the preparations constantly 
on hand in readiness for use without delay when 
occasion may require. 

There is no known means by which the growth and 
development of germs may be more efficiently checked 
than by the use of 

Cold. — Cold applications should be made to the 
throat externally, and the patient should be allowed 
to hold small bits of ice in the mouth and to swallow 
them occasionally. The cold applications must be 
made thoroughly enough to reduce the temperature of 
the throat as near the freezing point as the patient can 
endure without suffering, as otherwise it will do al- 



THE A T M E XT. 5 J 



most nothing toward modifying the morbid process. 
The best mode of accomplishing this is to apply to the 
throat compresses composed of several folds of linen 
or cotton — flannel may be used when necessary — be- 
tween the folds of which are placed numerous small bits 
of ice, or small quantities of snow. The intensity of 
the cold may be regulated by the quantity of ice or 
snow used. When the patient cannot bear so great a 
degree of cold, compresses may be applied wrung out 
of cold or iced water. The compress must be large 
enough to cover the throat and extend well around the 
sides of the neck. 

To guard against too prolonged lowering of the 
temperature and circulation of the part affected, once 
an hour or two the cold compress should be removed 
and the throat fomented for ten to twenty minutes. 

Some authors condemn the use of cold upon the 
supposition that it is employed to destroy the germs. 
This is not the case. The object hoped to be gained, 
and which is really accomplished, is the retardation of 
the growth and development of the disease-producing 
organisms which are present in the parts affected. 

2. The next result to be attained is the subduing of 
the local inflammation. Very happily, the very same 
remedy which restrains the development of the 
parasitic organisms, also the most satisfactorily meets 
this indication for treatment. Cold is well established 
as the best antagonist of local inflammation, as well 
as general febrile action. 

No remedy could be more appropriate. The direc- 
tions already given for its application need no further 



52 DIPHTHERIA. 



addition, except it be the caution that care should be 
exercised that the clothing of the patient and the bed- 
clothing do not become wetted by the melting of the 
ice or snow and dripping from the compress, as un- 
pleasant chilliness may be thereby induced. 

3. Relief of the suffering of the patient arising 
from the irritation of the throat and the swelling of 
the adjacent glands is another important indication to 
be met. This is usually accomplished in large degree 
by the cold applications, which although some- 
times unpleasant to the patient, from their soothing 
effects become very grateful to him. Another very 
important measure is the administration, at intervals 
of one to two or three hours, of hot fomentations, ap- 
plied by means of flannels wrung out of water as hot 
as can be borne by the patient. The fomentations 
should be renewed every four or five minutes until 
three or four applications have been made. Hot poul- 
tices of linseed meal, bread and milk, or other pasty 
substances may be applied for an equal length of time. 
Mustard plasters, if used at all, should be applied very 
carefully, and for only a very few minutes. Blisters 
are never advisable, as they will leave a raw surface 
which will be a fertile field for the growth of a false 
membrane, and thus become a new source of infection 
of the blood. Hot fomentations thoroughly applied, 
secure all the good results of blisters with none of 
their ill effects. 

4. To alleviate the suffering due to difficulty in 
breathing and swallowing, and to facilitate the remo- 



TEE A TMENT. 53 



val of the false membrane, also requires the applica- 
tion of proper remedies. The hot applications al- 
ready described greatly aid in securing these results ; 
but there is no single remedy so efficient as the inhala- 
tion of hot vapor. It is not necessary that the vapor 
should be medicated, although such volatile disinfect- 
ants as chlorine and carbolic acid may be added in 
very small proportions with benefit. The important 
thing is that the vapor should be as hot as can be 
borne by the patient without discomfort. A tempera- 
ture of 110° to 120° will be borne without diffi- 
culty by most patients. This remedy soon affords the 
patient so much relief that even little children mani- 
fest a very great appreciation of it. The inhalation 
should be practiced once or twice an hour at first, and 
ten to fifteen minutes at a time. The warm vapor 
acts like a poultice in relieving the swelling, soreness, 
and spasm, and in facilitating the separation of the 
false membrane. In cases of croupous diphtheria, es- 
pecially when the larynx is involved, this remedy is 
almost the sole reliance for saving the patient's life. 

Different modes of applying this remedy have been 
suggested. It is of the greatest importance that it be 
done thoroughly. A very good plan is to attach a 
rubber tube to the nose of the tea-kettle. A tin tube 
can be readily made by a tinner if rubber cannot be 
obtained. As the steam is generating, let the patient 
hold one end of the tube in his mouth and inhale the 
warm vapor as freely as he can. 

Another very good plan is this : Place in an 



54 DIPHTHERIA. 

ordinary tea-pot a few good sized pieces of freshly 
burned lime. Pour on the lime a boiling hot mixture 
of vinegar and water. Close down the cover, and let 
the patient breathe the vapor through the nose. The 
lime and solution can be renewed as the quantity of 
vapor diminishes. This is a very good plan if well 
carried out. The best of all arrangements for this 
object is an apparatus constructed for the purpose, 
in which the steam is generated by an alcohol lamp or 
a gas flame. Every family ought to have an appara- 
tus of this sort to use, not only in diphtheria, but in 
croup, for which it is the best remedy, for ordinary 
colds and sore throats, for catarrh, and for local or 
general vapor baths, to which it is admirably suited. 

No attempts should ever be made at the forcible re- 
moval of the membrane. If it is torn off, the mucous 
membrane is left sore and often raw, or bare. When 
removed thus, another membrane is sure to form. If 
allowed to remain until removed by the efforts of nat- 
ure, a sound and healthy membrane is left when it 
comes away. 

The removal of the membranes may be effected by 
the inhalation of solutions of substances which have 
the power to dissolve them chemically. A moderately 
strong solution of lime-water, or of vinegar, answers 
well for the purpose. An atomizing apparatus is re- 
quired, which may be attached to the vapor apparatus 
already referred to. In cases of diphtheria of the 
larynx, this is a very important measure indeed, and 
must be used very thoroughly. 



TEE AT ME XT, 55 



The administration of a light emetic is often advan- 
tageous in effecting the dislodgment and expectoration 
of the membranes. A copious draught of lukewarm 
water is usually sufficient for the purpose ; but if 
emesis does not follow its repeated use. a small dose 
of ipecac or of some other simple emetic, followed by 
warm-water drinking, will be sure to induce vomiting. 

When the nasal cavity is obstructed by false mem- 
branes, thorough syringing should be resorted to, the 
solution consisting either of equal parts of good vine- 
gar and warm water, or a solution of lime, five grains 
of freshly burned lime to the ounce of water. The 
syringing should be continued fifteen or twenty min- 
utes at a time, and renewed at brief intervals until 
the membrane is softened and comes away in pieces. 
The face of the patient can be protected during the 
syringing so that the skin will be in no way unpleas- 
antly affected. Usually very great relief may be 
given the patient by this measure. 

To prevent general infection of the system by ab- 
sorption of the diphtheria organisms into the Hood. 

All of the remedies already mentioned aid in an- 
swering this indication by limiting the local inflam- 
mation and checking the development of the organ- 
isms. Whatever renders them less active will deter 
their penetration of the mucous membrane ; and what- 
ever lessens the inflammation of the membrane, ren- 
ders it better able to resist the attacking parasites 
and repel their encroachments. Disinfection of the 
mouth and throat, and the application of cold, are as 



56 DIPHTHERIA. 



efficient remedies to hinder general infection as can 
be employed. 

Ventilation, the common name for air disinfection, 
is of the greatest importance, next to disinfection of 
the mouth and throat. This point has already been 
dwelt upon at sufficient length under the head of 
" Prevention. " 

Deodorants, such as ozone, and other non-offensive 
agents, may be employed to great advantage with ap- 
propriate apparatus, for the purpose of purifying the 
air of the sick-room. Chloride of lime, carbolic acid, 
and sulphurous acid are too offensive and annoying to 
the patient to be used in this way with benefit. Prob- 
ably no agent is so useful for this purpose as ozone, 
one of the most powerful disinfectants known. A so- 
lution of permanganate of potash thrown into the air 
by an atomizer is a very good deodorant. 

GENERAL TBEA TMENT. 

ALTHOUGH efficient local treatment is of primary 
importance in this disease, general measures are of 
almost equal value in controlling the symptoms of this 
serious and so often fatal disease. While those who 
have regarded the disease as essentially of a general 
character have failed by disregarding the local mani- 
festations, those who consider it primarily local in 
character have too often failed by neglecting to give 
due attention to the general manifestations of the 
malady. Both classes of symptoms and effects must 
receive due attention. 



TREATMENT. ffi 



The two indications for general treatment of great- 
est moment are, 1. To subdue the general fever; 
2. To sustain the patient until the invading organisms 
can be repelled. 

1. For subduing the fever no remedy equals water 
in antiphlogistic effects. In general, the febrile ac- 
tion accompanying diphtheria does not rise so high as 
in most other febrile diseases ; yet this symptom is 
one of no small importance. Unless the patient is 
sinking in collapse, the fever usually rises in propor- 
tion to the severity of the local affection. On the 
other hand, it will be found by those who will give 
this point particular attention that the local affection 
will become less intense in its activity when the fever 
is controlled by treatment. As before remarked, no 
remedy excels water for this purpose. It may be ap- 
plied in several ways with equally good effects. Both 
the graduated full bath and the wet-sheet pack may 
be employed with advantage when the fever is high ; 
but tepid sponging, with the application of large 
compresses applied about the trunk, after being wrung 
out of cool or tepid water, are generally sufficient to 
control the temperature in this disease, and are much 
more easily administered, also giving the patient much 
less inconvenience than the more heroic measures. 
They have also the advantage that they are less likely 
to be abused so as to harm the patient. These meas- 
ures should be employed with greater or lesser frequen- 
cy according to the height of the fever. If the tempera- 
ture is not over 100°, the pulse at ninety, skin only 



58 DIPHTHERIA. 



moderately warm, dryness of mouth and skin, and 
thirst not very marked, face not deeply flushed, a 
tepid sponge bath two or three times a day will be all 
that is required in addition to the local treatment. If 
the temperature rises to 103°, more vigorous meas- 
ures must be used. A sponge bath should be given 
once in an hour or two, and a linen compress of three 
or four thicknesses, large enough to cover the front 
and sides of the trunk, must be applied after being 
wrung out of tepid or cool water. The compress 
should be changed every twenty minutes ; and the 
cooler it can be applied without discomfort to the pa- 
tient, the better. When the fever rises still higher, 
with usual symptoms of great thirst, dryness of lips 
and skin, hot and flushed face and skin, full, rapid 
pulse, apply sponge bath every half hour and change 
compress once in ten or fifteen minutes until the fever 
abates. 

Care must be taken continually in the use of water 
in this disease, that the patient has no tendency to- 
ward collapse. If the pulse begins to flag, is slow 
and feeble, while the skin is cool, no cooling applica- 
tions are necessary. Warm applications are needed. 

Care should be exercised continually that the limbs 
are kept warm. Cool compresses may be applied to 
the head, even the ice-cap when necessary. 

At the outset of the disease, when the patient often 
complains of chilly sensations, a w^arm blanket pack, 
given by wringing a woolen sheet out of water a little 
above blood heat and wrapping it snugly about the 



TREATMENT. 59 



patient, will be found a very excellent remedy, not 
only for the chilliness, but also for the muscular sore- 
ness, which is also a frequent symptom of the outset 
of the disease. 

Diarrhea, vomiting, nosebleed, and the other minor 
symptoms sometimes accompanying this affection, are 
to be treated in the usual manner. 

2. For sustaining the patient, too great reliance is 
put by many in the large use of iron and frequent 
feeding. We have never seen sufficient evidence of 
the utility of these methods to convince us of their 
efficiency. Others use stimulants in great quantities, 
which we believe to be productive of more harm than 
good. What the patient needs is nutrition, not stim- 
ulation. If overcrowded with food, and plied with 
aliment at too frequent intervals, the nutritive appa- 
ratus will have no time for the elaboration of food. 
and no time for rest. It will be always engaged in 
the preliminary work of digestion. The overworked 
stomach will be sure to fail up with indigestion, and 
the patient will really receive a much smaller amount 
of available nutrition than if food is taken in proper 
quantities at intervals sufficiently far apart to allow 
time for digestion. 

Give the patient three meals a day at regular hours. 
Let the diet consist principally of oatmeal or barley 
gruel, with fruit and milk toast. If there is diffi- 
culty in swallowing solid food, let the patient have 
plenty of milk, with a moderate allowance of beef 
soup or broth. 



60 DIPHTHERIA. 



In addition to the various measures mentioned, lit- 
tle else is needed but good nursing. Very little medi- 
cation is required, if any. Many physicians employ 
only local medication. We usually prescribe teaspoon- 
ful doses of a saturated solution of chlorate of potash 
once in one to three hours, hoping thereby to destroy 
some of the germs which find their way into the 
stomach. 

If the patient falls into a state of collapse, the pulse 
being slow and weak, the skin cool, the respirations 
rapid, with the other usual symptoms of that condi- 
tion, the temporary use of stimulants may be useful. 
We have used electricity, both the galvanic and the 
faradic, in such conditions, with excellent results. 
Dry heat is also a useful stimulant in such cases. All 
may be used in conjunction. 

Paralysis and the other secondary affections which 
often follow this disease should be treated on the gen- 
eral principles governing the treatment of those affec- 
tions from whatever cause. In the case of paralysis, 
after the disease is fully developed, electricity should 
be employed. This, with out-of-door exercise and 
time, will effect a cure in most cases. 

Tracheotomy is a surgical operation sometimes per- 
formed when the symptoms indicate imminent danger 
of suffocation ; but before it is resorted to, the condi- 
tion of the patient is already so hopeless that recov- 
ery rarely occurs. 



APPENDIX. 



RULES FOR THE RESTRICTION AND PREVEN- 
TION OF DIPHTHERIA, 

The following rules have been prepared by the Michigan State 
Board of Health for general circulation. We take the liberty to 
present them here on account of their excellence. Copies can be 
obtained of the Secretary of the Board, Dr. H. B. Baker, of 
Lansing, Mich., to whom we are indebted for several copies. 

1 . Every person known to be sick with this disease should be 
promptly and effectually isolated from the public; — one or two 
persons only should take the entire charge of the patient, and they 
should be restricted in their intercourse with other persons. 

2. The room in which one sick with Diphtheria is placed 
should previously be cleared of all needless clothing, carpets, 
drapery, and other materials likely to harbor the poison of the 
disease. . This room should constantly receive a liberal 6upply of 
fresh air, without currents or drafts directly upon the patient. It 
will be well also to have the sun shine directly into the room. 

3. The discharges from the throat, nose, and mouth, are ex- 
tremely liable to communicate the disease, and should be received 
on soft rags or pieces of cloth which should immediately be burned. 

4. The discharges from the kidneys and bowels are also danger- 
ous, and should be passed on old cloths and burned, or into vessels 
kept thoroughly disinfected by nitrate of lead, chloride of zinc, or 
sulphate of iron (copperas), and then be buried at least 100 feet 
distant from any well. 

Copperas, dissolved in as little hot water as will dissolve it, is a 
good disinfectant for this purpose. 

5. Nurses and attendants should be required to keep themselves 
and their patient as clean as possible ; — their own hands should 
frequently be washed and disinfected by chlorinated soda. 

6. Soiled bed and body linen should at once be placed in boiling 
water or in water containing chlorinated soda, chlorinated lime, or 
solution of chloride of zinc. 

(61) 



62 APPEXDIX. 

7. All persons recovering from Diphtheria should be considered 
dangerous, and therefore no such person should be permitted to 
associate with others or to attend school, church, or any public 
assembly, until in the judgment of a careful and intelligent phy- 
sician he can do so without endangering others. 

8. The body of a person who has died of Diphtheria, should as 
early as practicable be placed in the coffin, with disinfectants ; and 
the coffin should then be tightly closed. Afterward, the body 
should not be exposed to view except through glass. 

9. No public funeral should be held at a house in which there 
is a case of Diphtheria, nor in which a death from Diphtheria has 
recently occurred. No children at least, and it would be better in 
most cases that few adults, should attend such a funeral. 

10. The room in which there has been a case of Diphtheria, 
whether fatal or not, should, with all its contents, be thoroughly 
disinfected by exposure for several hours to strong fumes of 
chlorine gas, or of burning sulphur, and then, if possible, it should 
for several days be exposed to currents of fresh air. 

To disinfect an ordinary room with chlorine gas : Having tightly 
closed all the openings of the room, place in it an open earthen 
dish containing four ounces of peroxide of manganese. Pour on 
this one. pound of strong muriatic acid, being careful not to breathe 
the fumes. When certain that continuous evolution of chlorine is 
taking place, leave the room and close the door. 

To generate sulphurous acid gas, put live coals on top of ashes 
in a metallic pan, and place on the coals sulphur in powder or 
fragments. 

A convenient way is to place the coals and sulphur on a heated 
stove plate or cover turned bottom upward in a pan half filled with 
ashes. To disinfect 100 cubic feet of air requires the thorough 
burning of about one and one-half ounces of sulphur. 

11. After a death or recovery from Diphtheria, the clothing, 
bedding, carpets, mats, and other cloths which have been exposed 
to the contagium of the disease, should either be burned, exposed 
to superheated steam, to a degree of dry heat equal to 240° F., or 
be thoroughly boiled. 

The foregoing methods of disinfection are applicable in all con- 
tagious diseases. 

12. Avoid the special contagium of the disease. 

13. Beware of crowded assemblies in ill-ventilated rooms. 

All influences which depress the vital powers, and vitiate the 
fluids of the body, tend to promote the development and spread of 
this disease. Among these influences, perhaps the most common 
and powerful are, impure air and impure water. Because of this, 



APPENDIX. 63 



and as a means of lessening the danger of contracting almost all 
other diseases, the following precautions should always be taken, 
but more particularly during the prevalence of any such disease as 
this. 

14. The grounds under and around the house should be well 
drained. 

15. No vegetable or animal matter should be allowed to decom- 
pose on the surface of the ground near the house. 

16. If any soap-factory, slaughter-house, rendering establish- 
ment, or other source of foul odors, contaminate the air which you 
and your children daily breathe, take immediate measures through 
your local board of health or health officer to have such nuisance 
abated. 

17. Your own privy, especially, should at all times be thoroughly 
disinfected, by dry earth, coal ashes, or copperas water; and the 
receptacle should be so constructed as to be water-tight and to be 
tightly covered when removed to be emptied, as it should be often 
enough to prevent the air about it from becoming offensive, and 
in cold weather so far as possible. 

18. Your whole house, and especially its sleeping-rooms, should 
be well ventilated. 

19. Your cellar should be dry and well ventilated; it should fre- 
quently be whitewashed, and always kept clear of decomposing 
vegetable or other substances. 

20. No cess-pool should be allowed near the house. If there be 
one, it should either be removed or be thoroughly and frequently 
disinfected with sulphate of iron (copperas). 

21. Your house drains should be looked to with scrupulous care, 
to see that they are well trapped, kept clear, and ventilated into 
the open air. 

22. Your house should not have uninterrupted connection with a 
sewer. Be sure that the waste-pipes do not permit the entrance of 
sewer gas into the house, but that they enter the sewer through 
an open-air space, or at least through a space freely ventilated to 
the open air. 

23. Be sure that your drinking- water is not contaminated by sur- 
face drainage, nor by leakage from the drain, gas-pipes, sewer, 
cess-pool, or vault. 

MICHIGAN STATE BOARD OF HEALTH. 



64 APPEXDIX. 



RULES FOR NURSING, 

On account of the great importance of nursing in this disease, 
we have appended the following suggestions, which are condensed 
from the " Household Manual of Hygiene," etc., published at this 
office : — 

1. Secure a constant supply of pure air from out-of-doors. 

2. Admit the light and sunshine freely. Direct sunlight is 
sometimes unpleasant to the patient; then shade the windows 
with white curtains, which will admit the light. 

3. Maintain equable temperature. More fire is usually needed in 
the morning and evening than at noon. Regulate the heat by a 
thermometer hung near the bed. The mercury should never be 
above 70°. m 

4. The patient himself should be kept scrupulously clean. The 
whole body should be washed several times a week, at least. The 
mouth and teeth should be daily cleansed. 

5. All discharges should be kept in covered vessels, and should 
be removed from the room at the earliest moment possible. 

6. The sick chamber should be made pleasant by tasteful ar- 
rangement of its contents, by flowers, simple pictures, etc. Fre- 
quent change in the aspect of the room is desirable. 

7. The patient should never be kept in a state of expectancy. 
When a promise is made him, fulfill it promptly. 

8. Whispering or low talking in the sick-room or adjoining 
rooms will arouse the patient's fears unnecessarily. Avoid it. 

9. Arrangements for the night should be made before the patient 
becomes sleepy, so that he may not be disturbed. 

10. All avoidable noises should be prevented. 

11. The covering of the patient in bed should be several light, 
porous blankets, rather than one or two heavy ones. 

12. Strangers and visitors should be prohibited from entering 
the sick-room of a feeble patient. Visiting will often determine 
a fatal issue of the disease. 

13. Water kept in a sick-room should be often changed. Never 
drink that which has been in the room more than a few minutes. 

14. Never annoy the patient by questions or too much conver- 
sation. 

15. Always recollect that Nature must cure. All you can do is 
to make the conditions as favorable as possible. 



HEALTH PUBLICATIONS, 

Issued by the Good Health Publishing Co., from its OfEce 
at Battle Creek, Michigan. 



Uses of Water in Health, and Disease.— A book for every 

physician and every family. Careful explanations and instruction are given 
respecting the uses of water as a preventive of disease, and as a valuable 
remedy in nearly all classes of maladies. In cloth, 166 pp., 60 cents; paper 
covers, 136 pp., 25 cents. 

The Household Manual. — A book that everybody wants. It is 
brim full of information on a hundred useful topics. Tells how to treat most 
common diseases successfully with simple remedies, how to disinfect and ven- 
tilate, what to do in case of accidents, how to resuscitate the drowned, and 
gives much other equally important information. Nearly 20,000 sold in two 
years. Bound, 172 pp., 75 cents. 

Plain Facts about Sexual Life. — The most complete and inter- 
esting book for the general public yet published on the anatomy and physiology 
of reproduction. The Boston Journal says of it, "A book so intelligently 
written should not lack for readers." Handsomely bound in cloth, 360 pp., 
$1.50; abbreviated, in flexible covers, $1.00. ( Revised edition in preparation.; 

Alcoholic Poison. —Or, the Physical, Moral, and Social Effects of 
Alcohol as a Beverage, and as a Medicine. This pamphlet is the best compen- 
dium of the temperance question published. The scientific part of the argu- 
ment is particularly full. Its statements are brief, concise, and to the point. 
Every temperance worker ought to have it. Paper covers, 128 pp., 25 cents. 

Healthful Cookery. —A Hand- Book of Food and Diet ; or, What to 
Eat, When to Eat, and How to Eat. It contains a large number of recipes for 
the preparation of wholesome and palatable food without condiments. Every 
dyspeptic ought to have it. Enamel paper covers, 128 pp., 25 cents. 

Proper Diet for Man.— A scientific discussion of tl\e question of 
vegetable versus animal food, together with a consideration of the relation of 
salt to the human system. Ultra notions are avoided, and the subjects treated 
are handled with candor. Price, in flexible covers, 50 cents. (In Press.) 

Dyspepsia. — A concise account of the nature and causes of this almost 
universal disease, with directions for its cure. Thousands have been cured by 
attention to the suggestions contained in this little work. 25 cents. 

Evils of Fashionable Dress, and How to Dress Health- 
fully. — This little work considers the subject of fashionable dress from a 
medical standpoint, and thoroughly exposes its evils. It does not stop here, 
but points out an easy and acceptable remedy. Ultra and peculiar notions of a 
character obnoxious to good taste find no place in this work. If every lady j»a 
the country would follow its common sense teachings, the greatest share of the 



Pub li she'd by Good Health Publishing Co., Battle Creek, Mich. 

peculiar maladies from which so many ladies suffer would be prevented. En- 
amel covers. 40 pp., 10 cents. 

Bound Volumes of the Health Reformer.— These valuable 
volumes contain more practical information of a vital character than any others 
of their size. Each volume contains 360 pages of reading matter, well bound. 
$1.50. 

■ .». . 

HEALTH AND TEMPERANCE TRACTS. 

Startling- Facts about Tobacco. —A description of the evil 
'effects of tobacco-using. Hundreds have been reformed by reading it. 32 pp., 
4 cents. 

Tea and Coffee. — A careful statement of the objections to the use of 
these popular beverages. 32 pp., 4 cents. 

Pork. — This tract exposes the filthy scavenger in all his uncleanness. It 
-destroys all appetite for ham and sausage. 16 pp., 2 cents. 

Health Annual. — Of the five annual editions, more than 400,000 have 
Tbeen sold. Ought to be in every family. Is full of valuable and interesting 
information about health and other practical topics. 10 cents. 

Twenty-five Arguments for Tobacco-Using' briefly An- 
swered. — Not even a shadow of excuse is left the slave tc< tobacco who has 
perused this pithy little tract. 16 pp., 2 cents. 

Wine and the Bible. — A demonstration that the Bible in no degree 
sustains the habitual use of alcoholic drinks of any sort. Just the thing for 
temperance work. 24pp., 3 cents. 

True Temperance. — This tract views intemperance as a far-reaching 
evil which includes every form of artificial stimulation, as well as alcoholic in- 
toxication. 4 pp., y 2 cent. 

Alcohol : What Is It ? An explanation of the nature of alcohol 
and its mode of production. 4 pp., % cent. 

Moral and Social Effects of Alcohol.— A forcible statement of 

facts and statistics. 8 pp., 1 cent. 

Cause and Cure of Intemperance. — A very valuable tract. Es- 
pecially designed for wide circulation. 8 pp., 1 cent. 

The Drunkard's Argraments Answered. —Leaves no excuse 
fur tipplers, either moderate drinkers or habitual drunkards. 16 pp., 2 cents. 

Alcoholic Medication. — A protest against the wholesale employ- 
ment of alcoholic compounds in the form of bitters, tonics, blood purifiers, etc. 
16 pp., 2 cents. 

%5W These tracts will be furnished at the rate of 800 pp. for $1.00. A lib- 
eral discount to Health Associations and others who take them by the quantity. 

4^ Any of the above publications will be sent free of postage to any ad- 
dress upon receipt of retail price. A discount of one-third allowed on orders 
amounting to $5.00 or upwards. 

Address, GrOOD HEALTH, 

Battle Creek, Mich. 



Published by Good Health Publishing Co., Battle Creek, Mich. 

THE HOUSEHOLD MANUAL 

Bound in Cloth, 172 pp., 75 cts. 

20,000 SOLD IN 18 MONTHS. 



This little volume is replete with useful information. The principal topics are 

Hygiene, Food and Diet, Simple Remedies for Common 
Diseases, Accidents, and Emergencies, Use- 
ful Hints and Recipes. 

As a reference book this handy volume will save a hundred times its cost 
«very year. 

WHAT SHALTWE EAT? 

Flexible Covers, 50 cts. (In Press..) 



This work, which has recently been rewritten and greatly enlarged, furnishes 
a candid, conclusive, and scientific answer to the question, 

SHALL WE EAT ANIMAL OR VECETABLE FOOD ? 

The subject is one which is now interesting from many different standpoints, 
and awakens general interest when properly broached. 

Without advocating any special system of diet for all persons under all cir- 
cumstances, the author presents in a concise and forcible manner the principal 

Scientific Arguments for Vegetarianism. 

In addition to a consideration of the foregoing subject, a portion of the work 
is devoted to answering a question which is receiving some attention by modern 
writers on dietetics, 

Is Salt a Wholesome or Necessary Aliment ? 

This question, like the former, is considered in a candid and scientific man- 
ner, and will be of interest to the reader whether he is familiar with the subject 
or not, as the most complete consideration of the subject to be found. Several 
thousand copies of the first edition have been sold in the last few years. 



Published by Good Health Publishing Co., Battle Creek, Mich. 



USES OF WATER. 



Bound in Cloth, 160 pp., 60 cts. Fape: Covers, 25 eta. 



A work for every family and every physician. It is the 

ONLY BOOK PUBLISHED 

which gives the latest scientific knowledge respecting the use of water as a 
remedy for disease. The instruction which it imparts is 

PLAIN, PRACTICAL. COMPLETE. 

Ever)' form of bath is described, together with the conditions to which it 
is adapted. 

Plain Facts About Sexual Life. 

Beautifully Bound, finely Tinted Paper, 360 pp., $1.30. 

-A. BOOK ECE, THE TIMES, 
Treating upon all subjects pertaining to the 

ANATOMY AND PHYSIOLOGY 
OF REPRODUCTION 

in a new and interesting manner. Plain, concise, and complete, yet wholly free 
from indelicacy, and perfectly chaste in expression. The following are a few 
of the numerous commendations received from the press : — 

"A book so intelligently written should not lack for readers." — Boston 
Journal, 

"The various subjects, though plainly set forth, are handled in a manner 
the most fastidious need not object to." — Haverhill Publisher. 

"A book well calculated to impart useful knowledge upon very important 
subjects." — Boston Heratd. 

"We can heartily commend it to parents for their own guidance and in- 
struction, as well as for the teaching of their children." — Boston Transcript 

SEND FOR CIRCULAR OF REVISED EDITION. 



Published by Good Health Publishing Co., Battle Creek, Mich. 



HEALTHFUL COOKERY; 

OR, HOW TO EAT, WHEN TO EAT, WHAT TO EAT. 

Enamel Cover, 128 pp., 25 cts. 



Cook books arc innumerable; but, with rare exceptions, they are to be classed 
among the most active causes of disease. This work claims to be one of the 
exceptions, and to that end is largely devoted to instruction in the art of pre- 
paring 

PALATABLE FOOD WITHOUT CONDIMENTS. 

15,000 COTIFS SO JOT). More than 15,000 copies of the work have 
been sold in the last ten years. Almost 

ANT DYSPEPTIC CAN CURE HIMSELF 

hy careful attention to its instructions. Free by mail on receipt of price. 

HEALTH ANNUAL 

48 pp., 10 cts. 



A splendid substitute for the quack-medicine almanacs, sown broadcast by 
^unscrupulous knaves who fatten upon the miseries of their fellow-men. Of the 
six annual editions of the work, 

MORE THM 400,000 COPIES EATE BEEN SOLD. 

It has found its way into all parts of the United States, Canada, Australia, 
Scotland, Switzerland, and even South Africa, and has become 

it:e3::e: most if'c^e'ttxj-^:^ ^TTBZjic-A-Tioasr ©ie 1 

jEach number is a treasury of condensed knowledge about health. It 

Ought to be in Every Family. 

A few copies of the editions for 1877 and 1878 can be furnished. To mission- 
ary societies and private individuals who wish to distribute them gratuitously, 
-a liberal discount is made by the quantity. 



Published by Good Health Publishing Co., Battle Creek y Mich. 

DYSPEPSIA. 

Price 25 Cents. (In Press.; 

This work is a revised and greatly enlarged editioa of a work of the same 
name of which 

More Than 25,000 Have Been Sold 

in the last four years. It explains clearly and very fully the 

NATURE, CAUSES, AND CURE 

of this almost universal disease, and thousands have been cured by- 
attending to the simple suggestions which it contains. 
SEND FOR CIRCULAR. 

ALCOHOLIC POISON: 

Its ^DoraJ., Social, a,aa.5L 2?:b.37-sic3il lEhfifects. 
Enamel Cover, 125 pp., 25 cts. 

An interesting, straightforward, and mest convincing argument for temper- 
ance. The author shows with striking clearness that 

Science, Experience, and the Bible Discountenance Intemperance. 

The causes of intemperance are faithfully pointed out, and efficient means of 
prevention and cure are suggested. 

Every phase of the temperance question is considered in this work concisely 
yet thoroughly, making it a 

Ocm plete Oo3oa.peaa.cLlvi.m. of Terapgra -n ca. 

Every person interested in the temperance question ought to own a copy, and' 
to aid in getting it before the public. 

EVILS OF FASHIONABLE DEESS, 

-A.23.6L ZKCow to HDress Hea.ltiLf-a.ll3r- 
Pamphlet, 40 pp., 10 cts. 

An unprejudiced criticism of fashionable modes of dress from a medical 
standpoint. The author shows that a most commendable reform in dressing 
may be made 

Without Adopting Styles Extravagant or Odd, 

and without making the wearer the object of ridicule on account of striking; 
peculiarity of appearance. The book is full of 

Soiiao-cV, 3?ra,etiea.l, Ooooo-aooLoao. Seao.se .A-cVsrice. 

Every mother and every daughter in the land ought to become acquainted! 
with the facts contained in this little work. If ladies generally would read and. 
heed its teachings, nearly all the diseases peculiar to the sex would disappear,. 
Sent free by mail on receipt of price. 



Published by Good Health Publishing Co., Battle Creek, Mich. 

Health Tracts. 



In no department of human improvement is there greater need of missionary 
work than in that -of health reform. Diseases are multiplying year by year, 
and human life is being curtailed, notwithstanding the great improvement made 
in sanitary protection, by the unhealthful habits of individuals. Domestic hy- 
giene is of even greater importance than public hygiene, since it interests a 
larger number of people and exerts a more powerful influence for good. 

The following series of tracts considers nearly every phase of the health 
question, and is admirably suited for general circulation. Of these tracts 
there have been 

HUNDREDS OF THOUSANDS SOLD. 



Thousands have increased their health and happiness a hundred-fold, as well 
as improved their financial condition, by attention to the principles so clearly 
set forth in these little monographs. 



VENTILATION. 
DISINFECTION. 
SALT. 

ANIMAL FOOD. 
HEALTHFUL CLOTHING. 



STARTLING FACTS about TOBACCO. 

PORK. 

PRINCIPLES OF HEALTH REFORM. 

TEA AND COFFEE. 

TWENTY-FIVE ARGUMENTS for TO- 
BACCO-USING Briefly Answered. 



The xo tracts aggregate nearly 200 pages of condensed information about health. 



In Neat Package, Free by Mai! for 25 Cents. 



(The first four named are in Press.) 



Published by Good Health Publishing Co., Battle Creek, Mich. 

TEMPERANCE TRACTS, 



Every temperance worker of experience knows that it is not unfrequently the 
case that 

A Tract Will Save a Drunkard. 

when personal appeals have failed, since there is no chance for an argument. 
This series of eight tracts has been prepared expressly for circulation by reform 
and missionary societies, and their use in this manner has been attended with 
good results. 

MORE THAN 200,000 CIRCULATED. 

Within the last two years, since these tracts were first published, edition after 
edition has been required until the aggregate exceeds 200,000 copies. They are 

Plain, Pointed, Practical 

appeals to the dram drinker's common sense, and present ever}- phase of the 
question in a new light. The set, consisting of eight tracts, constitutes one of 
the most complete compendiums of arguments for temperance ever published. 
Put up in a neat package, free by mail for 10 cents. (For particular descrip- 
tion of each tract, see book list on preceding pages.) 

School of Hygiene, 

The Only School of the Kind in America. 



This newly organized school offers every desired facility for the successful 
study of 

HYGIENE >ND SANITARY SCIENCE. 

Instruction is given in the form of familiar lectures, illustrated by numerous 
experiments, charts, blackboard drawings, etc., making subjects usually 
thought dry and uninteresting, really fascinating. 

J$ : £^ Term opens September 1, and continues during the fall and winter. 

For further information, send address for Annual Catalogue, to 

J. H. Kellogg, M.D., 

BA TTLE CREEK, MICIf. 



Published by Good Ileal! Ji Publishing Co., Battle Creek, JSIich. 

GOOD HEALTH. - 

Monthly, 32 pages, $1.00 a Year. 

THE BEST HEALTH JOURNAL IN THE WORLD. 



This journal, formerly known as the Health Reformer, has long enjoyed the 

LARGEST CIRCULATION OF ANY HEALTH JOURNAL 

in this or any other country. This eminent popularity is doubtless attributable 
to the fact that this journal, now (1879; just beginning its fourteenth volume, has 
always been 

A PRACTICAL JOURNAL FOR THE PEOPLE. 

As many persons cannot afford the expense of several periodicals, the pub- 
lishers have lately increased the scope of the journal so as to make it meet, so 
far as possible in a single journal, the various wants of the common people in 
the direction of 

PHYSICAL, MENTAL, AND MORAL IMPROVEMENT. 

Health, 

Home Topics, 

Choice General Literature, 
Science, 

Practical Suggestions for the Household, 
News and Miscellany, 

Are the topics considered in its monthly columns. The journal is 

A Mil of Typographical \hkm and Accuracy, 

and its publishers offer it at a rate so low as barely to cover the expense of pub- 
lication, so as to enable the journal to do the greatest amount of good by 
sreaching the largest number of people possible. 
^ Send stamp for specimen copy, to 

GOOD HEALTH, 

BATTLE CREEK, JSIICH. 



Medical jmp Surgical Sanitarium. 

Incorporated i8bb. 
For many years this institution has been widely known as 

THE 

LEADING HEALTH INSTITUTION 

IN THE WEST. 

Within the last two years extensive improvements have been made, in the 
erection of a large new main building, the laying out of lawns, erection of a 
large fountain, and the introduction of all the latest improvements in the line of 

NEW MEDICAL & SANITARY APPLIANCES. 

The most efficient and scientific methods of heating and ventilation have 
been adopted at an expense of move than $25*000 for this item alone, more 
than ten miles of steam pipe being used in the building. The ingenious combi- 
nation of direct and indirect radiation secures equable warmth under all circum- 
stances ; and an improved method of adding moisture to the air in winter, 

SECURES THE ADVANTAGES OF A MILD CLIMATE, 

which makes this a place especially desirable for persons of delicate lungs. 
Another great advantage of this institution is its 

SALUBRIOUS LOCATION, 

on an elevated site, above the malaria go prevalent in many Western States. 

All Valuable Remedial Agents are Employed. 

The institution is not a ''WATER CURE," a "MOVEMENT CURE" 
a "DIET CURE," a "HOSPITAL," nor a "REST CURE," but all com- 
bined, with the addition of all remedial agencies known. 

Chronic Diseases and Surgical Cases 

A SPECIALTY. 

Those who find it necessary to go abroad for their health cannot do better 
than to patronize this institution. 

JI^SEND FOR CIRCULAR. *%» 

J. H. KELLOGGr, M. D., Medical Superintendent 

SANITARIUM, 

BATTLE CREEK, MICHIGAN. 
SIEIE CTTT OUST OPP;SITE JPA<3-"E. 



Medical and Surgical Sanitarium, 




BATTLE CHEEK, MICH. 



For Sale by Sanitary Supply Co., Battle Creek, Mich. 



ANATOMICAL CHARTS. 



Either Cutler's or Marshall's Anatomical Charts, which exhibit in a most 
1 teautiful manner 

Every Minute Structure of the Human Body, 

Can be furnished at lowest rates. Every school ought to have a set of these 
.maps Every teacher ought to own a set, so as to be able to impress practical 
foots relating to health upon his pupils. 

Anatomical Models and Anatomical Preparations of Man and 
Lower Animals, of all descriptions, can be supplied at lowest rates. 



TEMPERANCE CHARTS. 



Every temperance lecturer ought to have 

SEWALL'S STOMACH PLATES, 

"which represent in the most graphic manner the effects of alcohol upon the 
fouman stomach. The series consists of 

33igr2a.t Largfe Colored. Clxa.rts, 
which have been prepared from drawings made from the stomach itself, so that 
they can be considered as thoroughly reliable. Nothing in the line of illustra- 
tion will produce so profound an effect upon an audience as these charts. 
SEND FOR CIRCULAR. 



BIND YOUR OWN BOOKS. 



By means of a recently patented invention it is possible for every person to 
bind his own magazines and other periodical literature. The invention consists 
of a cover with a spring back, so constructed that it may also be used as a paper, 
or magazine file. When the cover is filled, the volume is as substantially bound 
as though it had just come from a bindery. 

Covei^ ioi " (S^ood SealtV 

with side title in gilt, sent free by mail on receipt of 50 cents. Address, 

Good Health, Battle Creek, Mich. 



:ett:r,:e:k:a ventilator. 

Thousands are dying annually for want of pure air. There is plenty of it,. 
but the difficulty is to get it in adequate quantities at all times, and in an unob- 
jectionable manner. 

FOUL AIR IS THE GREATEST CAUSE OF CONSUMPTION. 

Scientific physicians long since decided that the greatest cause of that dread 
disease, pulmonary tuberculosis, is the breathing of impure air. The Eureka 
Ventilator secures 

Thorough Ventilation in Coldest Weather, Without Draughts, Without Smoke. 

The apparatus is so simple that it cannot get out of order, and so- 
cheap that everybody can have it. Can be applied without 
expense, to any house. 

The Eureka is now in use at the Sanitarium of this place, and gives most 
perfect satisfaction. Send stamp for circular. Address, 

Sanitary Supply Co., Battle CreeJc, Mich* 

izmupzrctv^ieid s"5nR,i.:N"a-:EJS- 

The Fountain Syringe has long held its place as the best of all articles of this 
sort; but recent improvements enable us to offer 

A Symingm Which. Mxcmjls Tmm Bmst, 

and one which we can unqualifiedly recommend. Its great advantages over 
the Fountain Syringe are chiefly that it is much more convenient to use, is 
more dxirable, and can be applied to a great number of purposes for which the 
Fountain Syringe is useless. It possesses 

ALL THE EXCELLENCIES OF THE FOUNTAIN 

SYRINGE WITH NONE OF ITS DEFECTS. 

PRICE: 

One Quart $2.50 [ Two Quarts $3.00 

Sent free by mail on receipt of price. 
Address, Sanitary Supply Co., Battle Creek, Mich, 



BATH AZPIPAZRATTTS 

Of all sorts furnished at 
lowest rates. For a fam- 
ily bath none is more con- 
venient than the 

UNIVERSAL 

PLIABLE BATH, 

represented in the cut. 

We can also furnish paper bath tubs of various shapes and sizes, which are 
as durable as, rubber, very light, and as impervious to water as though made of 
tin. JEuery family heetis a Jiath of some sort, and such convenience, if 
properly used, greatly enhances the health of the several members of the family. 

Each bath sold is accompanied by a copy of "Uses of Water," as a 
guide to its use. Send Stamp for circular. Address, 

Sttnitary Supply Co., Battle Creek, Mich. 




THE SANITARY DETECTIVE, 



The almost universal adulteration of all classes of articles of every day use, 
including food and other articles by the use of which life may be endangered, 
makes it a matter of greatest importance that 

EVERY MAN SHOULD BE HIS OWN CHEMIST, 

at least sufficiently to detect the dangerous frauds which are daily becoming 
more frequent and numerous. 

Fortunately, the means for detecting the most common adulterations are so 
simple that they may be acquired by anybody with a little instruction, and 
with the proper materials for use. 

The Sanitary Detector will enable a person to accomplish the following very 
important objects : — 

To Detect Adulterated Sugar. To Detect Alum in Bread. 
To Detect Parasites in Sugar. To Detect Lead in Drinking Water. 
To Detect Arsenic in Wall-Paper. To Detect Lead in the Coating of Tin- 
To Detect Adulterated Honey and j ware or Tin-lined Vessels. 

Sirup. i To Detect Lead in the Glazing of 

To Detect Poisonous Colors in Arti- ! Earthenware. 

cles of Clothing. ', To Detect Lime in Water. 
To Detect Lead in Canned Fruit and To Detect Organic Matter in Water. 

other Foods. ! To Detect Carbonic Acid in the Air. 

These are all sources of danger to life to which every one is exposed at all 
times. A small investment will enable one to protect himself, his family, and 
his friends. Send stamp for circular, to 

SANITARY SUPPLY CO., 

BA TTLE CREEK, MICH. 

DISINFECTION. 

Everybody now understands the importance of disinfection, but few are ac- 
quainted with the best methods, or supplied with the best means of application. 
To supply this long-felt want we are prepared to furnish, at lowest rates, 

Best Materials for Disinfection. 

Full directions for applying will be sent with the materials. We can also 
supply efficient nt'-ans for disinfect >ng sick-rooms without annoy- 
ance to the patient. This is a matter of great importance in diphtheria and 
typhoid fever, as well as all febrile diseases. By destruction of the germs the 
patient has a better chance for recovery, and the danger of communication of 
the disease to others is greatly lessened. Send for circular, to 

SANITARY SUPPLY CO., 

BATTLE CREEK, MICH. 



PORTABLE VAPOR BATH. 

One of the most effective of all known means of treatment for Colds, foi 
jRheumsftisin, for Neuralgia % for Dropsy, Obes'ty. and not a few 

other diseased conditions of a serious nature, is the vapor bath. But the ordi- 
nary means at hand for giving a vapor bath at home are so rude that the best 
results cannot be obtained, if any good can be done. 

.A. COMPLETE OUTFIT 

for administering a vapor bath in a most efficient manner will be furnished at 
reasonable rates. The same apparatus answers well for 

Fomentations and Inhalations, 

and can also be used as a disinfector. Send stamp for circular to 

Sanitary Supply Co., Battle Creek, Mich. 

DIPHTHERIA & CROUP REMEDY. 

It has been demonstrated again and again that in bad cases of croup and 
■diphtheria, especially the latter, 

Inhalation is the Best Remedy. 

The only drawback to its efficient use is the want of suitable appliances. Tc 
meet this want we offer an apparatus which is simple and effective, and by 
thorough use 

MAY SAVE THE PATIENT'S LIFE, 

when other means have failed. The same apparatus also supplies the means 
for applying the 

BEST TREATMENT FOR NASAL & PHARYNGEAL CATARRH. 

It ought to be in every family, in readiness for use if needed. Full directions 
for use are sent. 

SEND STAMP FOR CIRCULAR. 
Address, Sanitary Supply Co., Battle Creek, Mich. 

HEALTH FOR THE TEETH. 

Clean teeth are as important for health as necessary for beauty. If allowed 
to go uncleansed they become unsightly, offensive, and soon decay. One box oi 

HYGIENIC TOOTH POWDER 

and a single cake of SANITARY DENTIFRICE, with a proper amounf 
of daily brushing, will keep the teeth white and clean for a year. Full direc- 
tions for use sent with each package. Package of each free by mail for 50 cents. 
Address, Sanitary Supply Co., Battle Creek, Mich. 



POCKET FILTER. 

most useful thing of the kind ever invented 
Only $1.50. 
Address, Sanitary Supply Co., Battle Creek, Mich. 



The neatest and most useful thing of the kind ever invented. Every traveler 
ought to have one. Only $1.50. 



CARBON FILTERS. 

Next to impure air, impure water is 

THE GREATEST CAUSE OF DISEASE. 

Typhoid and typhus fevers, with many other febrile diseases, originate In 
impurities in water. We have long been looking for 

.A. PERFECT FILTER, 

and are pleased to be able at last to present it to our patrons. From jbsen a 
tions made during the last two or three years we are obliged to pronounce 

THE KEDZIE FILTER A FAILURE, 

for the following reasons, which the experience of many will at once corroborate" 
i. They are only good when new, and are then often defective. 

2. They require very frequent renewal. 

3. They sometimes become .'(tensive and a source of contamination of water 
rather than a means of purification, after a few weeks' use. 

4. They not infrequently become breeding places for germs. 

5. Lead is em-ployed in their manufacture , which is itself a source of con- 
tamination. 

6. They require a great amount of attention. 

7. 'They are so large and cumbersome to handle that they cannot be easily 
moved. 

None of these objections apply to the 

IMPOMTEI) CAttBOir FILTER 

which we now offer. These filters are manufactured in London, Eagland, 
where they have the indorsement of the highest sanitary and chemical author- 
ities. The following are some of the advantages of these filters : — 

1. They are the most perfect purifiers of water ever invented. 

2. They last a long- time without change. 

3. They never become contaminated by germs. 

4. They can be renewed at any time at a few cents' expense, should re- 
newal become necessary. 

5. On account of their rapid and efficient action, they can be made small 
a ud portable. 

ALL SIZES AND STYLES FURNISHED, 

from a small pocket filter, to use in traveling, to a filter that will furnish several 
hundred gallons an hour. 

Sjnd stamp for price list, to 

Sanitary Supply Co.. 

BATTLE CREEK, MICK. 



